Sudden, unexpected pediatric death due to previously undiagnosed natural disease is relatively uncommon.  This lecture outlines the differences between a pediatric forensic autopsy and an adult forensic autopsy, and provides an overview of the major categorical considerations when infants and young children die suddenly of natural disease.

Despite improvements in infant mortality, the sudden, unexpected and apparently unexplained death of an infant remains a relatively commonplace event.  By 2020, the majority of cases can be found to be the result of an infant being placed to sleep in an unsafe environment (e.g. bed-sharing with an adult).  This lecture provides an overview of infant death investigation, and a conceptual approach to the analysis and (statutory) certification of deaths of infants dying suddenly.

In early 2020 the National Association of Medical Examiners (NAME), in coordination with the SUDC  Foundation, published a reference book (Unexplained Pediatric Deaths: Investigation, Certification, and Family Needs) which contained practice recommendations written by experts from the forensic pathology, public health and the clinical pediatrics communities.  These recommendations span numerous topical areas including death scene investigation, how to perform a pediatric autopsy, and death certification.  This lecture provides an overview of these practice standards.

Few forensic pathology topics are as controversial as abusive head trauma (including “shaken baby syndrome”).  This lecture provides an overarching perspective on both impact and non-impact head trauma (i.e. shaking), common pathological findings in injured and deceased children, and introduces attendees to fundamental (and controversial) topics such as retinal hemorrhages, “shearing injury” (“DAI”, “tDAI”, “TAI”, etc.), short falls, BECC/BESS, and lucid intervals.

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A brand new policy statement on abusive head trauma was released by the American Academy of Pediatrics in March of 2020.  Like the 2019 Society for Pediatric Radiology Consensus Statement on abusive head trauma, this controversial publication has the potential to significantly impact practitioners, the legal system and society.  This lecture provides an overview of the policy statement, and discusses its strengths, weaknesses and core controversial elements.

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Over the past decade or more, the infant cervical spine has become a topic of great importance in the evaluation of apparently injured (living and deceased) infants who may have been shaken or had impact injuries.  This lecture reviews the core pathological elements of hyperflexion/hyperextension injuries of the spine in both radiological and pathological settings, as well as common mimics of injury that may result in misdiagnoses.

The investigation of the apparently criminal death of a toddlers is highly complex, and requires interdisciplinary cooperation (without the development of “group think” and other forms of bias).  Careful interviews of suspects, thorough pediatric forensic autopsy techniques, and careful consideration of pathologic findings (which may have relevance in the determination of a “timeline”) are all key.  When standard “adult” autopsy techniques are utilized in young child cases, tremendous medical evidence may be lost, and this may result in a miscarriage of justice (a guilty person may not be charged or may be found innocent; an innocent person may be charge or found guilty).  This lecture provides an overview of these critical issues.

The discovery of fractures in living and deceased children can be alarming.  It is critical that all practitioners understand the developmental anatomy of growing bones, the common mimics of fractures, pathological conditions that predispose to fracture, and the basic biomechanics that apply to fracture generation and morphology.  Most pediatric fractures are not criminal in origin; the discovery, documentation and interpretation of fractures in this population can have tremendous consequences.  Skull fractures, rib fractures, and extremity fractures (including “CMLs” or “classic metaphyseal lesions”) are covered in this lecture.

Torture of infants and young children is, thankfully, an uncommon event in the United States.  However, it is critical that torture cases are appropriately identified, documented and presented to the criminal justice system.  On the other side of the coin, over-diagnosis of torture can have tremendous negative consequences, particularly given the subsequent legal sequelae in many jurisdictions.  This lecture reviews the medicolegal aspects of child torture.

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