INFANTICIDE

Learning objectives:
1. Define infanticide, viability and maturity.
2. Define points of identification of an infant.
3. Recognize live birth and still birth.
4. Recognize causes of death in infanticide.

Infanticide is the intentional killing of a liveborn infant (during the first year of
life), by the mother or any other person. Thoughlegal definitions vary among different
countries, the medical concept of infanticide is uniform.

In Egypt the deliberate killing of a new-born or an infant might be murder, but

under certain circumstances if done by the mother the penalties should therefore be
different. The crime may be equivalent to manslaughter. This is due to an
appreciation that a woman might, because of birth or lactation, be suffering from
mental disturbance and so be only partly responsible for her actions. Killing of an
infant by the mother is, infact, a well recognized medical and psychiatric
phenomenon that distinguishes it from other types of homicide. Filicide is the act or
fact of a parent, especially a father, killing his or her own son or daughter.

In reporting on cases of suspected infanticide, the following questions should be

answered:-

1. Is the infant viable or non viable, mature or premature? What is the stage of
maturity?

2. What are the points of identity does the infant show?

3. Was the infant born alive? (live-born or still-born).
4. How long did the infant survive after birth?
5. What is the cause of death of the infant?
6. What is the time passed since its death?

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 I- Viability and maturity
Definition of viability:-It is the potential ability of an infant to survive after birth.
An immature fetus may be born alive, but be incapable of maintaining an
independent existence. The age of viability is taken as 6 months gestation, though
this now a legal problem as a fetus of a younger age can now survive with intensive
medical support. Estimation of maturity is necessary to proof viability before either
stillbirth can be recorded or a charge of infanticide brought. Maturity can be
assessed from the length, the weight, general appearance, the appearance of centers
of ossification as it is mentioned in the chapter of abortion.

II- Identification of the infant

The date and place where the infant was found should be identified. The body,
wrappings and everything connected with the body (e.g. bags, blankets and
newspapers) should be thoroughly examined.

The wrappings are examined for its nature (e.g. paper or cloth), and then for the
presence of meconium or well-formed stools.

The presence of a piece of clothes, in which the infant has been wrapped, may
form good evidence against a suspected woman when part of these wrappings can be
found in her house.

Body features e.g. colour of skin, the hair and the presence of birth mark or
congenital anomalies in the infant’s body are all points helpful to identify the infant.

Blood grouping and “DNA genetic fingerprinting” will obviously add greatly to
identification.

The appearance of the cut end and any ligation of the umbilical cord may help
to decide whether the birth was one where medical or nursing attention was
available.

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 III- Live or Still Birth
Legally, an infant can not be considered live born unless it has shown signs of life
(e.g. breathing) when completely separated from the mother. Thus a child that is
breathing when the head is delivered but dies while one foot is still in the vagina, is
in fact a still-birth.

So, still-birth refers to any child which has delivered after six months of
pregnancy and did not at any time, after being completely expelled, breath or show any
other signs of life. The placenta and umbilical cord do not however count as part of the
body.

Signs of life (live birth):

(i) Non-medical evidence: witness stating that the infant cried, sneezed, opened its
eyes, moving a limb ....

(ii) Medical evidence: live birth may be proved

by: External signs of live-birth:

1- The vital changes around the base of the umbilical cord:

- A ring of hyperaemia appears: one day after birth.
- Start of ulceration in the ring: three days after birth.
- Complete separation of the stump: one week after birth.
- Complete healing of the stump by scar: Two weeks after birth (Umbilicus is
formed).

2- Desquamation of the skin: Starts 2 or 3 days after birth on the trunk and complete
in 2 weeks.

3- Presence of antemortem wounds (e.g. wounds due to application of forceps).

4- Presence of yellowish well-formed stools in the wrappings denote live-birth. It
must be differentiated from the dark green meconium, which is not a sign of live-

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 birth as it may be expelled from the intestine of a still-born squeezed during
difficult labour.

5- The skin may still have vernixcaseosa present. If not present it may indicate that
the child had been washed, which suggests survival for some time after birth.

Signs of still-birth:
1- Maceration: means death of infant in utero. It is a destructive aseptic process
appears 2 to 3 days after death. Maceration includes characteristic rancid smell,
brownish discoloration of the skin, blistering or peeling of epidermis together
with softness and flattening of the body. There are mobile skull bones and loose
limbs.

IV- The time of survival of the infant

The following signs help to estimate the age of the infant:
1. Floatation of the stomach and intestines, and the presence of well-formed stools in
the large intestines.

2. The changes in the skin around the base of the umbilical cord.
3. Desquamation of the skin.
4. Ante-mortem injuries of the infant and vital reaction.
5. Changes in the cardiovascular system (umbilical vessels, foramen ovale and ductus-
arteriosus).
The age of the infant has to be compared with the time passed since delivery in a
woman suspected to be its mother.

V- Causes of Death
a) Natural and Accidental causes:
1- Prematurity.

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2- Congenital abnormalities (e.g. anencephaly, severe spina bifida..) 3-
Accidental prolapse of the cord resulting in anoxia.

4- Accidental suffocation with mucus from maternal passages.

5- Accidental strangulation by the cord .
6- Infection e.g. bronchopneumonia, umbilical sepsis.
7- Blood disorders e.g. erythroblastosisfoetalis.

b) Unnatural causes:

• Acts of omission: negligence to do what is necessary for the continuance of the

life of a newly born infant. It is a rare condition, and in some cases it may be
involuntary due to illness or ignorance of the mother. The proof of lack of care
in this case required witnesses and clinical opinion. These acts include: Neglect
to feed the infant (starvation). Neglect to cloth the infant to protect it from cold
(hypothermia). Neglect to remove the mucus or amniotic fluid from its mouth
(obstruction of the airways). Neglect to tie the cord cause death from
haemorrhage, since the umbilical vessels begin to contract some hours after
birth and occluded within few weeks.

• Acts of commission: These are positive acts designed to cause infanticide.

Therefore it is necessary to exclude the possibility of birth injury and
accidental trauma. Violence including all possible homicidal causes may be
used.

a) Violent asphyxia: this may be by:

• Strangulation: presents the usual features of bruises and abrasions on the neck,
though these may be minimal. The classical features of asphyxia may be present but
are often absent presumably because of the ease with which the vulnerable infant
dies. The umbilical cord may be used as a ligature in case of strangulation, this will
show displacement of the Wharton’s jelly with evidence of violence (e.g. bruised,

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 torn by the rough handling), the constriction mark in the neck is usually ill defined
because it is of soft structure.

• Smothering: is almost impossible to prove. Only if excessive pressure is applied,

pressure marks are left on the lips (specialy on the inner surface) and face. Similar
marks may be produced by the hands during self-delivery, but are then probably
distributed widely over the surface of the head, on the eyebrows, ears and the chest.

• Choking: Internal obstruction of the pharynx, by various materials, is excessively

uncommon these days.

b) Stabbing with scissors, either in the chest or neck has been seen, or even cutting
throat with blade. In these cases, the defence may be offered that the wounds
were inflicted accidentally during frenzied efforts by the mother to cut the
umbilical cord.

c) Drowning is unusual form of infanticide, but is more often a way of disposing of

an already dead child.

d) Burning and poisoning are rarely resorted to and probably leave visible external
antemortem signs.

e) Head injuries may result from smashing the head against a wall or stone or even
striking the head with a hard heavy object, causing usually extensive injuries
with depressed or comminuted fractures occurring any where in the skull even in
the temporal or occipital bones radiating to the base of the skull. Brain injuries
(contusion, laceration), subdural and subarachnoid haemorrhages are common.
External injuries on the face, head and other regions of the body may also be
found. The defense in such cases usually raises the question of precipitate labour
and fall of the child to the ground, or raises the question of difficult labour and
instrumentation.

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• Precipitate labour: the birth occurred suddenly without any previous warning, in
the erect position. The mother is usually multipara. The foetal head will be
relatively smaller in comparison with maternal passages, with no caput and no
moulding. Non depressed fissure fracture at one of the eminences, usually at the
frontal and parietal eminence, is common. It is not accompanied by scalp
lacerations. In such cases, the placenta may still be attached to the infant. The
umbilical cord is irregularly torn, or in some cases, the cord may be long enough
to reach from the uterus to the ground.

• Difficult labour: the mother is usually a primipara, and the foetal skull is
relatively large in comparison with the maternal passages. The disproportion
produces a well-formed caput succedaneum (a serous birth swelling on the head)
with moulding of the skull bones. If fracture of the head occurs, it generally takes
the form of simple fissure.

• Forceps application: result in depressed fracture having the same shape of the
curved blade with laceration of the scalp.