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A Review of Blunt Force Injury Homicides of Children Aged 0 to 5 Years in Bexar County, Texas, From 1988 to 2009

Molina, D. Kimberley MD*; Clarkson, Arthur MD; Farley, Katherine L.; Farley, Norma J. MD§

The American Journal of Forensic Medicine and Pathology: December 2012 - Volume 33 - Issue 4 - p 344–348
doi: 10.1097/PAF.0b013e31821a88c4
Original Articles

It is essential that clinical physicians, medical personnel, medical examiners, and law enforcement agencies understand the types of injuries seen and demographics of children affected by intentional blunt force as this understanding can be crucial to the death and/or criminal investigations. An understanding of the injuries can also assist in drawing conclusions regarding how those injuries could have been sustained. This study discusses the types and patterns of injuries seen in blunt force homicides in children younger than 6 years. The study found that male infants are more often intentionally injured than are female infants and that fatal head injuries most frequently occur in the first year of life, whereas most fatal thoracoabdominal injuries occur in the first 3 years of life. In children with head injuries, subdural hemorrhage was the most common finding, followed by subarachnoid hemorrhage. In 2.5% of deaths due to head injury, concurrent neck injury was seen, a percentage far lower than previous literature would suggest if shaking was the primary mechanism of injury. Twelve legal confessions were also reviewed, none of which disclosed a pure mechanism of shaking the infant.

From the *Bexar County Medical Examiner’s Office; †San Antonio Uniformed Services Health Education Consortium, Wilford Hall Medical Center and Brooks Army Medical Center, San Antonio; ‡Texas A&M University, College Station; and §Valley Forensics, Harlingen, TX.

Manuscript received January 28, 2011; accepted March 12, 2011.

The authors report no conflicts of interest.

Reprints: D. Kimberley Molina, MD, Bexar County Medical Examiner’s Office, San Antonio, TX. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.