Experimental modelling of imposed upper airway obstruction in infants and children. 2020

George Johnson, and Frederick Green, and Harriet Clift, and Christopher Paul Johnson
Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, Merseyside, L9 7AL, UK. georgejohnson93@gmail.com.

The interpretation of injuries to children and infants poses a number of difficulties to any medical practitioner involved in their care or tasked with the investigation their death. This includes differentiating accidental from non-accidental trauma and the consideration of medical factors making a child more prone to injury. Non-fatal but life-threatening upper airway obstruction is unfortunately a well-recognized pattern of abuse which may precede a fatal episode. In this experimental study, we aimed to model theoretical digit marks to the head using infant and young child resuscitation dummies, exposed to various methods of deliberate upper airway obstruction. This work has demonstrated that digit marks can be left anywhere on the head and face. However, the distribution of these marks varies dramatically based on how the airway was obstructed. Moreover, digit marks also appeared to be linked together in fairly reproducible patterns. Given the findings in this study, the identification of one or more fingertip type bruises anywhere on an infant or child's face or scalp, should raise the index of suspicion that the individual may have been subject to deliberate upper airway obstruction. This should prompt healthcare professionals to examine the child for markers of mechanical asphyxia, in order to accurately interpret any inadequately explained bruising to the head and face.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D008348 Manikins Inanimate physical models which bear likeness to human beings and are used for various purposes in place of humans. Mannequins,Manikin,Mannequin
D010781 Photography Method of making images on a sensitized surface by exposure to light or other radiant energy. Photographies
D002649 Child Abuse Abuse of children in a family, institutional, or other setting. (APA, Thesaurus of Psychological Index Terms, 1994) Abuse Experiences, Childhood,Child Neglect,Child Neglect Experiences,Child Neglect, Physical,Childhood Abuse Experiences,Childhood Neglect Experiences,Neglect Experience, Childhood,Neglect Experiences, Childhood,Physical Neglect, Childhood,Child Maltreatment,Child Mistreatment,Abuse Experience, Childhood,Abuse, Child,Child Neglect Experience,Childhood Abuse Experience,Childhood Neglect Experience,Childhood Physical Neglect,Childhood Physical Neglects,Experience, Child Neglect,Experience, Childhood Abuse,Experience, Childhood Neglect,Maltreatment, Child,Mistreatment, Child,Neglect Experience, Child,Neglect, Child,Neglect, Childhood Physical,Neglect, Physical Child,Physical Child Neglect,Physical Child Neglects
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D003288 Contusions Injuries resulting in hemorrhage, usually manifested in the skin. Bruise,Bruises,Contusion
D005151 Facial Injuries General or unspecified injuries to the soft tissue or bony portions of the face. Injuries, Facial,Facial Injury,Injury, Facial
D005385 Fingers Four or five slender jointed digits in humans and primates, attached to each HAND. Finger
D005554 Forensic Medicine The application of medical knowledge to questions of law. Legal Medicine,Medicine, Forensic,Medicine, Legal
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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