chapter  5
28 Pages

Child Abuse by Drowning

ByKAREN J. GRIEST

The incidence, location, and circumstances surrounding drowning and neardrowning in children are dependent on the age of the child and the child’s environment. The highest incidence of drowning from all causes in any age group occurs in 0-to 4-year-old children, and drowning is the second highest cause of unintentional death in this age group.1-3 In 0-to 4-year-old children, the sites of drowning are predominantly bathtubs, buckets, small bodies of fresh water, and swimming pools.1-3 Drowning during child abuse is also found in the 0-to 4-year-old group of children and occurs predominantly in bathtubs, buckets, and secluded, small bodies of fresh water (Table 5.1).1,2,4-6 Distinguishing between accidental and non-accidental drowning in infants

5.1 Introduction 103 5.2 Overview of Drowning in Infants and Young Children 104 5.3 Overview of Bathtub Drowning in Young Children 104 5.4 Pathophysiology of Drowning 105 5.5 Clinical Aspects of Drowning 106

5.5.1 Clinical Findings in Drowning 106 5.5.2 Pulmonary Aspects of Drowning 108 5.5.3 Dry Drowning 109 5.5.4 Neurologic Aspects of Drowning 109 5.5.5 Cardiovascular Aspects of Drowning 110 5.5.6 Laboratory Findings in Drowning 110 5.5.7 Frothy Exudate, Pleural Effusion, and Lung

Weight in Drowning 111 5.5.8 Petechial Hemorrhages in Drowning 111 5.5.9 The Temporal Bone in Drowning 111 5.5.10 Organ Weights in Drowning 112 5.5.11 The Autopsy in Drowning 112

5.6 Child Abuse by Drowning 114 5.7 The Investigation in Drowning 120 References 128

and young children can be difficult. Therefore, knowledge of the circumstance, autopsy findings, and clinical aspects of both accidental and abusive drowning are necessary to make the diagnosis of child abuse by drowning.