Fatal Head Injury and Nonaccidental Trauma in a Neglected Child with Disability: A Case Report

Multiple injuries were noted on the face and scalp, including scalp contusions of varying colors, ranging from red, dark red and brown to yellow, and a healing wound with granulation tissue at the center and an underlying contusion (Fig. 2).The brain showed subdural and subarachnoid hemorrhages.Features of raised intracranial tension were present, as evidenced by flattening of gyri and narrowing of sulci.Multiple hyperpigmented scars with pale centers were present in varying dispositions on the outer aspect of both lower limbs (Fig. 3), which might be from frequent beating.A healing metaphyseal fracture was noted on the right tibia (Fig. 4), and bony callus formation was confirmed by histopathological examination (Fig. 5).This injury caused deformity of the right lower limb, which was stated as congenital deformity by the caregivers.In the left leg, there was a healing epiphyseal fracture of the tibia, underneath a hyperpigmented scar with a pale center (Fig. 6).Histopathological examination of the left tibia showed devitalized bone with fibrovascular tissue and areas of hemorrhage (Fig. 7).Fractures of the tibia on both sides could be a result of localized blunt trauma, as the IntroductIon Kempe et al. defined "Battered baby syndrome" as a clinical condition in young children who have received serious physical abuse, generally from a parent or foster parent. 1 Child abuse and neglect include all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (e.g., a religious leader, a coach, or a teacher) that results in harm, the potential for harm, or threat of harm to a child. 2 The synonyms are child abuse syndrome, nonaccidental injury of childhood, shaken baby syndrome, maltreatment syndrome and Caffey syndrome.Differently abled children are among the most vulnerable members of our society.Physical abuse and neglect of children are not uncommon in India.But most of the cases were unreported or unrecognized.This case report portrays the evidence of silent suffering and neglect, revealed by the postmortem examination. HIstory o f t H e caseA 7-year-old girl was brought to the emergency department of a local government hospital with a history of vomiting at her home.On examination, she was found unresponsive and was declared dead.She was living with her maternal uncle and his partner, as her mother was working as a housemaid abroad.Her father had abandoned them a few years back.As per the history provided by the relatives, the child had congenital hearing and speech impairment.She was not able to walk or stand properly due to congenital anomaly of the lower limbs and had a history of frequent falls at home. autopsy fIndIngsThe child was emaciated and pale, with a height of 104 cm and weight of 11 kg.On inspection, there was shortening of the right lower limb (Fig. 1).