ABMDI Investigating Infant and Child Deaths 2 — Questions and Answers
Question 1: SUID (Sudden Unexpected Infant Death) investigations require a comprehensive scene response because:
- All infant deaths are presumed homicides until proven otherwise
- Scene investigation provides critical data to distinguish SIDS from accidental suffocation, overlying, and non-accidental trauma (Correct answer)
- Infant deaths always require criminal prosecution
- Scene investigation in infant deaths is optional and at the discretion of law enforcement
Correct answer: Scene investigation provides critical data to distinguish SIDS from accidental suffocation, overlying, and non-accidental trauma
Scene investigation including sleep environment documentation is essential to differentiate SIDS from accidental suffocation, overlying, and inflicted injury.
A thorough SUID investigation includes documenting the exact sleeping position, sleep surface, bedding, co-sleeping circumstances, room temperature, and infant's last known living status. This data, combined with autopsy and medical history, allows classification into SIDS (diagnosis of exclusion), accidental suffocation, overlying, or undetermined.
Question 2: When investigating a suspected SIDS death, the MDI should use which of the following standardized tools?
- DSM-5 diagnostic criteria for grief disorder
- CDC's Sudden Unexplained Infant Death Investigation (SUIDI) Reporting Form (Correct answer)
- FBI's Uniform Crime Report template
- Joint Commission patient safety event form
Correct answer: CDC's Sudden Unexplained Infant Death Investigation (SUIDI) Reporting Form
The CDC's SUIDI Reporting Form provides a standardized, nationally validated tool for SUID scene investigations.
The SUIDI form captures critical data: sleep position, surface, environment, caregiver information, last feeding, immunization history, and scene photographs. Using a standardized form ensures consistent data collection across jurisdictions and supports research on sleep-related infant deaths.
Question 3: Which pattern of injury in an infant raises the strongest concern for non-accidental trauma (child abuse)?
- A single bruise on the forehead of a mobile infant (cruising stage)
- Multiple bruises of varying ages on non-mobile areas, unexplained by the caregiver's history (Correct answer)
- A linear abrasion on the knee of a toddler who is learning to walk
- A superficial burn on the back of the hand of a school-age child
Correct answer: Multiple bruises of varying ages on non-mobile areas, unexplained by the caregiver's history
Multiple bruises in non-mobile locations (torso, ears, neck, face in a non-mobile infant) of varying ages and unexplained by history are highly concerning for abuse.
The TEN-4 rule is a validated clinical tool: bruising on the Torso, Ears, or Neck in children under 4 years, or ANY bruising in infants under 4 months, has a high specificity for abuse. Multiple bruises of varying ages (indicating repeated injury), bruises inconsistent with the developmental stage, or injuries inconsistent with the provided history all warrant concern.
Question 4: Abusive Head Trauma (AHT) in infants may present with which autopsy finding?
- Only external skull fractures
- Subdural hematoma, retinal hemorrhages, and diffuse axonal injury without evidence of external impact (Correct answer)
- Petechiae limited to the extremities
- Exclusively posterior rib fractures
Correct answer: Subdural hematoma, retinal hemorrhages, and diffuse axonal injury without evidence of external impact
AHT classically presents with the triad of subdural hematoma, retinal hemorrhages, and diffuse axonal injury, which may occur without visible external trauma.
The classic triad of AHT includes subdural hematoma (from bridging vein rupture), retinal hemorrhages (from accelerative-decelerative forces), and diffuse axonal injury (from rotational shearing). These may occur without scalp or skull injury. Additional findings may include neck ligament injuries and rib fractures.
Question 5: In child fatality investigations, sentinel injuries refer to:
- The fatal injury that caused death
- Minor injuries (bruising, oral frenulum tear) that preceded the fatal event and were not evaluated medically (Correct answer)
- Standard autopsy findings in SIDS cases
- Injuries only found during external examination before autopsy
Correct answer: Minor injuries (bruising, oral frenulum tear) that preceded the fatal event and were not evaluated medically
Sentinel injuries are often minor, pre-existing injuries that preceded fatal abuse. Their presence suggests ongoing abuse that went unrecognized or unreported.
Research shows that many abused infants who die had prior minor injuries (frenulum tears, bruises, metaphyseal fractures) that were sentinel events. MDIs should review medical records carefully for prior injury documentation. These findings have implications for improving systems of child protection.
Question 6: When investigating a child homicide, which additional resource team is commonly activated in many jurisdictions?
- FBI Behavioral Analysis Unit (BAU)
- Child Death Review Team (CDRT) or Multidisciplinary Investigation Team (MDT) (Correct answer)
- National Transportation Safety Board (NTSB)
- Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF)
Correct answer: Child Death Review Team (CDRT) or Multidisciplinary Investigation Team (MDT)
Child Death Review Teams or Multidisciplinary Investigation Teams bring together law enforcement, child protective services, MDIs, and medical professionals to conduct coordinated investigations of child fatalities.
MDTs and CDRTs provide coordinated, multidisciplinary response to child fatalities. Members typically include law enforcement, CPS, MDIs, pediatric specialists, prosecutors, and public health professionals. This approach prevents agencies from working at cross-purposes and improves case outcomes.
ABMDI Investigating Infant and Child Deaths 2
SUID (Sudden Unexpected Infant Death) investigations require a comprehensive scene response because: