The Impulse or Angry Homicide

The majority of cases of infanticide or child murder fall into this category. These children are the victims of a sudden violent act brought on by a slight or trivial provocation. The perpetrator is often a husband or boyfriend or, less often, the mother. Children crying or dirtying their diapers give rise to a sudden venting of suppressed anger and frustration by the perpetrator. Typically, the child is picked up and thrown or slammed against an object, floor, or wall. Aside from the fatal injuries, the child may be relatively well cared for and well nourished. Some might show a few minor old injuries but not the severe multiple injuries of different ages shown by children of the battered baby syndrome. Death is usually caused by head trauma. Less commonly, there are severe abdominal injuries following a blow or kick to the abdomen. The severe nature of the internal injuries may not be visible externally. Occasionally, cases presenting as SIDS have turned out to be impulse homicides with massive non-visible (at least externally) head or abdominal trauma. Explanations for the trauma usually are "He fell out of my arms"; "I was throwing him up in the air and catching him when I missed"; "He fell from his high chair"; "He rolled off the bed"; and so on.

Some individuals use immersion of a child in hot water as a disciplinary measure. Thus, an individual might plunge a child's hand or foot into boiling water to "teach" him not to perform a certain act. The forensic pathologist, however, more commonly sees the child who has been lowered into water up to his waist. Children who incur intentionally induced scalding burns are initially seen in the emergency rooms of hospitals, usually with a story that the child had been accidentally burned. Often, there will be a delay between the time of the injury and the child's being brought to the emergency room. Adults will usually ascribe this to their not having realized the severity of the injury. Yet, one will be presented with a child with second- or third-degree burns over half of the body with injuries so severe as to be obvious to even a layperson. The story of how the burns are incurred usually follows one of a few scenarios. The individual may say that they were bathing the child and did not realize the water was so hot until the child began to scream. Yet, these same adults show no evidence of any burns to their hands. With older children, they state that the child climbed into the bathtub and turned on the hot water and inexplicably was unable to get out. A variation of this is that the child was placed in the bathtub and a sibling turned on the hot water. A careful analysis of these stories shows they do not make sense, nor does the pattern of burns match the history.

In most cases of child abuse caused by scalding, adults intend to punish the child for some infraction such as dirtying a diaper. Typically, they will run water into a sink or bathtub, grasp the child underneath or by the arms and lower them into the water. What they fail to realize is that the water heater in many houses and apartments is set at around 140 °F. At this temperature, full-thickness burns can be inflicted in a matter of several seconds following immersion.11 As the temperature of the water decreases, the time needed to inflict full-thickness burns increases.

On lowering a child into the water, the child's feet contact the water first. This causes an involuntary withdrawal of the feet such that there is flexion at the knees and hips. Thus, the child is immersed in a squatting position. In most instances, the water is not very deep, somewhere between 6 and 12 in. Because of the position of the child as it is placed in the water, there will be a very characteristic distribution of burns (Figure 12.6). The skin in the popliteal fossae and in the knee region is spared because the child flexes its legs such that the knees project above the water and the flexed thigh and calf protect the skin of the popliteal fossa. If the thigh is brought back hard against the abdomen, which is often the case, there may also be sparing of the inguinal regions. If the child is wearing a diaper and immersion is not very long, there may be some sparing of the inguinal region by the diaper.

Table 12.3 shows the correlation between water temperature and time necessary to cause epidermal damage and full-thickness burns. It is based on

Figure 12.6 (A) Illustration of usual distribution of scalding burns with sparing of knees, popliteal fossae, and inguinal regions. (B) Sparing of knees (continued).
Figure 12.6 (continued) (C) Sparing of popliteal fossa.
Table 12.3 Water Temperature in Relation to Scalding Burns Time

Temperature (°°F)

Threshold for epidermal injury

Full-thickness burns

120

290 s*

600 s

125

50 s

120 s

130

15 s

30 s

140

2.6 s

~7 s

150

<1 s

* s = seconds human experimentation.11 Because the individuals involved were adults, it is probable that the times are actually shorter for young children since they have thinner, more delicate skin.

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