In North Carolina, a new chief medical examiner has brought a renewed emphasis on child death investigation training.
That doesn’t mean North Carolina hasn’t been doing good things in the area of child death investigation before 2010, when Dr. Deborah Radisch replaced Dr. John D. Butts Jr., who served as the state’s chief medical examiner for 23 years.
In 2000, the North Carolina Office of Chief Medical Examiner added the position of child death scene investigator/trainer. Lisa Mayhew has held the position since then and trains law enforcement officers. (North Carolina doesn’t have local death investigators who go to death scenes.)
When she first started, Mayhew says the state didn’t have standard operating procedures specific to child deaths, so she and others in the NC Child Fatality Prevention Program developed materials to cover the basics. Her book “Child Death Investigations: Interdisciplinary Techniques from Cradle to Court” was published in 2007.
Early on, Mayhew says she found the biggest problem was law enforcement investigations were lacking critical details. “If you have a death and no one knows how that death occurred, then a thorough investigation needs to be conducted, whether the victim is 2 weeks old or 80 years old,” she says.
Today, Mayhew reports the medical examiner’s office is getting the more detailed information it needs. That’s especially important with infant deaths, which make up almost half of the approximately 600 child cases reported to the Medical Examiner System for medicolegal investigation. Each year in the United States, more than 4,500 infants die suddenly of no immediately, obvious cause, according to statistics from the CDC.
Autopsies will not reveal all the answers, as the American Academy of Pediatrics states. In the organization’s official journal, Pediatrics, a February 2001 article titled “Distinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities,” describes the difficulty of child cause of death differentiation more specifically, noting “It is impossible to distinguish at autopsy between SIDS and accidental or deliberate asphyxiation with a soft object.”
Medical examiners and pathologists rely on law enforcement to bring them good, detailed information about what a scene has indicated and what various caregivers or witnesses say to help medical examiners properly interpret what they see at the autopsy table.
Dr. Tracey Corey, the chief medical examiner for the State of Kentucky, says, “The practice of medicine involves taking a history and physical. Since our patients can’t give us that history, we rely on law enforcement.”
Death investigators (and patrol officers — the first to arrive at a child death scene) need to have a basic understanding of pediatric cases. Because sudden, unexplained child deaths are not as common as other experiences they might have on the job, law enforcement personnel must rely on good training and good tools.
Child vs. adult homicide investigations
To understand child death investigations means understanding everything that’s known about adult death investigation can’t just be applied to children, Corey says.
Corey is a consultant to the FBI National Center for the Analysis of Violent Crime within the Child Abduction Serial Killer Program, and serves on the research advisory board thereof. As an instructor for the Public Agency Training Council (PATC), Corey teaches a separate section on pediatrics when she talks to law enforcement officers about death investigation.
“Children get different natural diseases than we do,” she says. “They die from different natural diseases than we do and they can respond differently to trauma than adults do. You have to always consider that children are not just little versions of us. We’re looking for different risk factors and hazards unique to the pediatric age group.”