Frenal injury in children is not pathognomic of non-accidental injury

Kidd, A. J.; Beattie, Tom F.; Campbell-Hewson, G.

doi:10.1136/emj.2009.075051

Cited by 6 publications

(2 citation statements)

References 3 publications

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“…The median age of the children with frenal injury was 19 months, and in all cases, the circumstances of the injury were thought to be accidental in nature. The most common reported mechanism of injury was a simple fall from a standing height (16 of 21 cases), while falls from objects such as furniture or toys and collision with a chair were also reported (four and one of 21 cases, respectively) (19). In their study on cardiopulmonary resuscitation-(CPR) related injuries and homicidal blunt abdominal trauma in children, Price et al identified one child in their control group of natural deaths who had sustained a lacerated frenum from oral intubation (20).…”

Section: Discussionmentioning

confidence: 99%

Are There Hallmarks of Child Abuse? II. Non-Osseous Injuries

Kepron

Walker

Milroy

2016

Academic Forensic Pathology

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Certain conditions have been considered hallmarks of child abuse. Such pathognomonic conditions have led to an inevitable diagnosis of inflicted injury. Forensic pathologists are faced with complex analyses and decisions related to what is and what is not child abuse. In this review, we examine the literature on the specificity of five conditions that have been linked to inflicted injury to varying degrees of certainty. The conditions examined include tears of the labial frena (frenula), cigarette burns, pulmonary hemorrhage and intraalveolar hemosiderin-laden macrophages as markers of upper airway obstruction, intraabdominal injuries, and anogenital injuries and postmortem changes. Analysis of the literature indicates that frena tears are not uniquely an inflicted injury. Cigarette burns are highly indicative of child abuse, though isolated cigarette burns may be accidental. Pulmonary hemorrhage is seen more commonly in cases with a history suggestive of upper airway obstruction, but is not diagnostic in an individual case. Hemosiderin-laden macrophages may be seen in cases with inflicted injuries and in natural deaths. Abdominal injuries may be seen in accidents and from resuscitation, though panreatico-duodenal complex injuries in children under five years of age are not reported to be seen in falls or resuscitation. The understanding of anogenital injuries is increasing, but misunderstanding of postmortem changes has led to miscarriages of justice.

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Section: Discussionmentioning

confidence: 99%

Are There Hallmarks of Child Abuse? II. Non-Osseous Injuries

Kepron

Walker

Milroy

2016

Academic Forensic Pathology

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show abstract

“…This study involves mostly ambulatory children. [ 31 ] It is plausible that a toddler can sustain accidental frenal injuries while learning to walk. In contrast, frenal tears in a younger and developmentally immobile child may be more suspicious, especially together with an inconsistent history.…”

Section: Context Of Frenal Injuriesmentioning

confidence: 99%