The last category of homicides in children is a very broad one, encompassing a multitude of different causes including poisoning, stabbing, clubbing, drowning, and shooting. Generally, the perpetrators fall into one of a number of types. There is the psychotic assailant, often a parent, who will shoot, stab, or club the child for some delusional reason. These assailants usually make no attempt to conceal their actions. They might say that the child was possessed by the devil or is the devil. Such deaths present very little problem to either the medical examiner or the police agency, because the perpetrators are quite willing to describe in detail what they have done and the cause of death is quite obvious.
The second type of perpetrator is the sane individual who commits murder for reasons that might or might not be apparent. Such an individual might use obvious violence (e.g., stabbing), but claim that the assailant was another individual, or that the child was kidnapped. They might attempt to make a death appear to be an accident. Thus, the perpetrator will relate that a child accidentally drowned in the bathtub or fell into a river. The deaths may be more subtle, especially if poison is used. Poisoning is very easy in children, because they are dependent on adults for feeding. The perpetrators are generally not psychotic, but just wish to dispose of a child for some reason or other. Because of this, it is a very good idea to perform complete toxicological analysis on young children in which no anatomical cause of death is apparent. This is especially true of SIDS cases. The authors have had a number of apparent SIDS deaths in which toxicological analysis revealed the deaths to be caused by drug overdose. In one 2-year span, one homicide was obvious, one was an accident blamed on the mother's misinterpreting the dispensation of medication, and a third undetermined as to manner, but most probably a homicide. In a fourth case, where a child died of asphyxia when cotton was wedged down its throat, there was also a toxic level of propyl alcohol in the blood.
Occasionally, infants and young children are killed by their siblings. They may beat them or even smother them. Sibling jealousy might be a motive.
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