Attention to Detail is Key in Child/Infant Death Investigations

A child is found unresponsive, prompting a frantic 9-1-1 call. Soon, police and other first responders arrive on scene. Sadly, the county coroner is summoned as the child has died, and chaos reigns as family members and friends are inconsolable.

But amid the bedlam, an investigation must be performed to determine the cause of death.

Cases involving the death of a child are unquestionably tough, but state medical examiner Dr. William Ralston said it’s imperative that the investigation is done right with all the “I’s” dotted and “T’s” crossed.

Ralston shared his observations with 36 law enforcement officers who took part in the inaugural Kentucky Criminalistics Academy Conference held at Cumberland Falls State Resort Park in Corbin.

According to DOCJT Special Topics Instructor Gabe Gillingham, Ralston’s presentation provided investigators across the state with valuable insight, which they can put into practice.

In addition to the special topics discussed during the week, the conference provides a means for law enforcement officers to network, share their combined experiences and learn from experts in a variety of fields.

“Child and infant fatalities are not a new phenomenon, (and) neither are some of the resources available to the investigators,” Gillingham said. “The information given during the Kentucky Criminalistics Academy Conference served as a good reminder to those experienced and armed new investigators in attendance with the information necessary to collect, process, and interpret evidence that can be a part of these crime scenes.”

The Scene

Every investigation starts at the location of the child’s death. These scenes are often key in explaining why a child died, Ralston explained.

But in several cases, the scenes are often overlooked and under-emphasized in deaths of children, he said.

“The scene gives us potential evidence,” Ralston said.

This is where the law enforcement officer’s attention to detail comes into play, Ralston said, using a possible Sudden Infant Death Syndrome (SIDS) scenario to illustrate his point.

“Is there food or a plant nearby the kid could have gotten a hold of?” he said. “When you go to the scene and talk with parents and family about drugs, the obvious question to ask, ‘Is your baby taking any medication?’ We fail to remember is anyone else taking medication? Who all lives here and what are they taking?”

Every scene detail must be noted, as it can help advance the investigation. This includes getting a timeline or history of events in the initial stages of the investigation. If it is discovered that a child has cracked ribs during the autopsy phase at the medical examiners' office and the on-scene police officer failed to ask if anyone performed CPR, it opens an avenue for a potential perpetrator to revise their story at a later date to explain away the injury findings.

“It is important to ask if anyone performed CPR,” Ralston continued. “If so, ask them how they did it. It would explain possible injuries.”

(Photo by Michael A. Moore)

Correlation of History

From the opening stages of the investigation, Ralston said officers must question everything and corroborate statements via a correlation of history. In a correlation of history, officers need to ask themselves:

• Is the pattern consistent?

• Is the distribution consistent?

• Is the site consistent?

• Is the severity consistent?

“We need to correlate the history with physical findings,” Ralston said. “With each injury, you want to compare it to those (above) four ways.”

A pattern injury is caused by blunt force and the object that created it or it could be an injury of a certain scenario, Ralston explained.

“If I get smacked with a hand, it’s going to leave this (type of) mark,” he added. “If I get hit with a wooden spoon, it’s going to leave this (type of) mark. That’s a pattern injury.”

If it is a case where a parent said the child fell off a sofa striking their head on the floor, Ralston said to measure the height from the sofa to the floor. Additionally, make a note indicating if the child fell on padded carpet or a surface such as a hardwood floor.

SIDS

Fatal cases involving infants under the age of 1 are often attributed to SIDS.

SIDS is a “diagnosis of exclusion,” Ralston said. “It remains unexplained even after autopsy.”

These scenes are emotionally charged as the officers suppress their own emotions, while simultaneously dealing with distraught parents, family members and friends while conducting the investigation.

The Center for Disease Control and Prevention’s Sudden Unexplained Infant Death Investigating Reporting Form (SUIDIRF) is a valuable tool to help keep the officer and investigation on track, Ralston explained.

“If you go to that form, you’re going to cover all the potential topics,” he said.

According to cdc.gov, the form is important for several reasons. These include:

• Standardizes data collection that may improve classification of sleep-related infant deaths

• Assists in determining an accurate cause of death by strengthening information about the circumstances of the death available before the autopsy

• Guides investigators through the steps involved in an investigation

• Allows investigators to document their findings easily and consistently

• Produces information that researchers can use to recognize new threats and risk factors for Sudden Unexpected Infant Death (SUID) and Sudden Infant Death Syndrome (SIDS)

Information collected on the form includes investigation data, witness interviews, infant’s medical history, infant’s dietary history, pregnancy history, incident scene investigation, investigation summary, diagrams and summary for the pathologist.

When completing a possible SIDS or any child-death investigation, it is important to take photos of the scene and injury to include in the file for review by the coroner and medical examiner.

“Pictures of scenes and pictures of injuries as you saw them are valuable,” Ralston said. “Injuries change over time. Potential hazards and injuries you’ve identified at the scene are all helpful and should be shared.”

Physical Findings

In the case of an infant’s death, the physical findings may be subtle, Ralston said.

“A detailed (correlation of) history will alert investigators of suspicious circumstances,” he said. “This isn’t going to be a situation where you walk in and it’s a bloodbath and a gun is laying there and shell casings are everywhere. It’s important that we get a detailed history because that may alert the investigator of suspicious circumstances.”

When investigating these scenes, Ralston said officers should take a close look at visible, physical injuries, and survey the surroundings for objects that could have caused the damage.

When it comes to instruments of abuse, the most common are the hands.

“It’s flexible, multi-sided and multi-dimensional,” he said. “The most common things we see are slap marks. But we may also see fist marks from punching, pinch marks and grab marks.”

But it is not limited to the hand. Nearly anything can be used as an instrument of abuse, and it is imperative that officers are detail-oriented.

Things to look for include items that are multi-sided, multidimensional and flexible. These can include items such as belts and extension cords. There are also injuries that appear to have come from a rigid object such as wooden spoons and curling irons.

“You’re in a house with tons of things that could have caused these injuries,” Ralston said. “Narrow it down to things that might have caused the injury. It will make it a whole lot easier. Look at patterns to see if injuries appear rigid or different. Look around the house for possible instruments.”

While many child/infant deaths can be attributed to accidents, don’t go into the situation with your guard down, Ralston said.

“In general, healthy children do not die as a result of minor household falls,” he said.