Intentional Starvation/Malnutrition and Dehydration in Children
Pediatric neglect can be defined as the failure of a caregiver to adequately meet a child’s basic needs, which include physical safety and protection, food, clothing, shelter, education, medical/dental care, and supervision.1-4 Neglect, the most common form of child maltreatment, accounts for approximately two-thirds of maltreatment cases, three times more common than physical abuse or battery.4-10 However, lethal neglect is not common. When neglect is fatal, the form is usually starvation and malnutrition and/or dehydration. Starvation, the deprivation of food and ultimately nutrition, and malnutrition, the lack of proper nourishment for the body’s metabolism and survival, can result in death. A child may be fatally neglected by means of dehydration with no signs of starvation or malnutrition. In some cases, the child is both starved/malnourished and dehydrated. The terms active and passive are also used to classify neglect. Active neglect involves a deliberate lack of care or the withholding of necessary components of a child’s care. Passive neglect occurs when a caregiver inadvertently does not provide for a child because his/her focus is elsewhere.2 This determination, based on the intentions and actions
7.1 Lethal Neglect 169 7.2 The Victim 170 7.3 The Investigation 170 7.4 The Postmortem Examination 171
7.4.1 The Autopsy 173 7.4.2 Microscopic Findings 180
7.5 Ancillary Studies 180 7.6 Secondary Infections 182 7.7 Mimickers 183 7.8 Conclusion 184 References 184
of the caregivers, can be difficult to make and relies greatly on the combined efforts of the forensic investigator and the forensic pathologist. A psychiatric evaluation of the caregiver may be needed to assess the possibility of mental illness and the psychosocial dynamics of the caregiver-child relationship.