Case Report |
Corresponding author: Ivan Tsranchev ( tsranchev@inbox.ru ) © 2022 Ivan Tsranchev, Pavel Timonov, Svetlozar Spasov, Todor Dobrev, Stela Yancheva, Milena Gulinac, Antoaneta Fasova.
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation:
Tsranchev I, Timonov P, Spasov S, Dobrev T, Yancheva S, Gulinac M, Fasova A (2022) Child abuse syndrome – a forensic case of fatal impulsive act of violence. Folia Medica 64(5): 834-839. https://doi.org/10.3897/folmed.64.e67042
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Child abuse syndrome is a medico-social problem widely spread around the world, which includes a complex of clinically manifested forms of violence against children. This syndrome includes different forms of physical violence, sexual violence, neglect, and emotional violence against children. The main problem with this type of violence continues to be the large number of unregistered “hidden” cases. The consequences of violence against children are serious and have a lasting negative effect on the physical and mental health of the victims. Child abuse is often a result of impulsive violent behavior with minimal provocation and may have a fatal outcome.
We present a case of a 3-year-old boy, admitted to the Emergency Department of the Municipal Hospital in Asenovgrad, Bulgaria, in a state of biological death. Case circumstances during the police investigation were unclear and the body was transported for forensic examination. During the forensic autopsy, many traumatic injuries were observed over the whole body – bruises of different ages, fractures of bones, abdominal trauma with bucket-handle tear of the mesentery, thoracic trauma with contusions and ruptures of the lungs, rupture of the diaphragm, and many other injuries that are specific predictors for this type of child physical abuse.
The main aim of the present report is to enrich the knowledge of medical workers in their routine practical work in the identification and determination of child abuse syndrome. It could prevent the fatal outcome and reduce the mortality from this specific type of violence.
child abuse syndrome, fatal physical injury, impulsive act, physical violence
The term ‘battered child syndrome’ was first described in the literature in the 1960s and was used by a number of pediatricians and radiologists in Great Britain after World War II.[
The corpse of a 3-year-old boy was received for post-mortem examination in the Department of Forensic Medicine of St George University Hospital, Plovdiv. The boy had been transported initially by his mother to the Emergency Department of the Municipal Hospital in Asenovgrad in the state of biological death. The mother provided vague and incomplete information to the police officers while they were taking a detailed history of the accident. She first claimed that the child had fallen down the stairs, then changed her story to include the child being beaten by other kids, and finally claimed that the child had accidentally choked while eating lunch. This contradictory information raised doubts in the doctors and the police officers. During the case investigation in the course of interrogation of the parents, it was established that the child was beaten by the mother’s intimate partner with multiple impacts such as kicking and aggressively throwing the child against a rigid bed frame in the house. The motive for this criminal act was also determined – the strong relationship between the child and the mother which systematically provoked aggression in the stepfather.
During the external examination of the corpse, numerous bruises were found over different body parts – in the region of the nose and the left half of the face, in the abdominal area, more specifically in the left groin area and left hip, as well as in the right lumbar region (Figs
Oval shaped bruises in groups seen on the left arm and left forearm with different stages of healing.
Patient’s lungs with multiple contusions of the parenchyma, clearly seen near the edges of the lobes and near the main bronchi.
(A) Lacerations over the inferior lobe of the left lung and over the middle lobe of the right lung; (B) Fractures of the 3rd to 6th ribs on the left along the midclavicular with hemorrhages in the area of the fracture lines.
Cases of aggressive, impulsive homicides of children after a sudden attack of provoked aggression are rare; these cases have a special place in the classification of violent deaths as a result of physical abuse against children. Usually, this type of abuse is associated with the impulsive and explosive nature of the violence – with multiple impacts, applied with great force for a short period of time, in combination with throwing the child against any hard interior surfaces – a process of sudden acceleration/deceleration of the whole body.[
Specific long bone fractures also can play an important role as predictors of this type of violence. These are the fractures of the distal intra-articular parts of the femurs (‘corner fractures’ and ‘bucket handle fractures’), fractures of the ribs, fractures of the scapulae, complex skull fractures (Le Fort I, II, III), vertebral fractures, fractures of the fingers of children who are unable to walk, as well as fractures of various ages.[
Based on all these established specific morphologic predictors of physical child abuse, in the present case, the lethal outcome could have been prevented if these features had been reported in time to the responsible government agencies and institutions by the mother or by the general practitioner during the routine medical examinations of the child. In most of cases of child abuse syndrome, an early diagnosis of the committed violence based on all these specific predictors could prevent the fatal outcome.
Child abuse syndrome continues to be a worldwide problem with significant importance.[
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The authors have declared that no competing interests exist.
All authors are part of this work in all its aspects by sharing and contributing their knowledge, expert opinion and expert practice skills.