PEDIATRICS Vol. 83 No. 1 January 1989, pp. 41-46
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Child Abuse by Drowning

Karen J. Griest MD1 and Ross E. Zumwalt MD1

1 The Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque

Drowning as a form of subtle fatal child abuse is difficult to distinguish from accidental immersion or from sudden unexpected natural death when the circumstances of immersion are concealed. Homicidal drownings are unwitnessed, usually occurring in the home, and the victims are young, either infants or toddlers. Accidental drownings are more likely to involve toddlers or older children in public areas such as swimming pools, drainage ditches, lakes, and rivers. This is especially true in rural areas. In cities, bathtubs remain a major site of accidental childhood drownings. Perpetrators of deliberate drownings often fit the sociopathologic profile of a child abuser. Because there is often a survival interval between immersion and death, pathologic findings consistent with postimmersion syndrome suggest the cause of death. Foreign material in the lungs, if immersion was other than in clear tap water, and injuries of the face are other positive correlating factors. A thorough investigation of the circumstances and cooperation between the investigating agency and the pathologist are essential to determine the correct manner of death in these cases.

Key Words: child abuse • drowning • immersion • nonaccidental death

Submitted on January 18, 1988
Accepted on March 17, 1988




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