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What Could Lead To An Infants Death After A Fall On Head?
Question: recently a family members 7month old infant fell off king size bed while sleeping. the child was developmentally slow {ie: could not sit up on his own, not crawling, below height range for age}. could roll over, soft spot on head had become mushy to the touch a few days prior to accident. the fall threw him over 18 - 28 inches from bed. he died w/I 24hrs. from blunt trauma to head. My question is what possible brain problems might have caused a seizure or whatever to land so far away from the bed? Appeared to hit back of head on closet door or dresser.
Brief Answer:
Extradural hematoma and brainstem compression
Detailed Answer:
Hi
Welcome to Healthcare-Magic
Greetings of the day
Dear XXXX
I am extremely sorry to hear about the accident.
The possible head injury that can be seen in 7 month old infant leading to demise is Extrdural Hematoma(EDH) .
An infant who can roll over , there is no surprise he can fall few inches from bed. Such injury causes bleeding in the extradural space (space between inside of skull boe and outermost covering of brain duaramater). This can induced seizure by compression along with associated cerebral oedema causing seizure. EDH causes compression of brain and leads to herniation of brain through the opening in skull, causing compression of brainstem. As Brainstem contains centre which control breathing and respiration, it leads on to cardio-respiratory arrest leading on to death.
In my pediatric surgery practice this has been the commonest cause.
I hope I have answered your query.
Do write to me if you need any further assistance.
Take Care
Best Regards
Dr Deepak Kishore
MBBS,MS,MCH
Consultant Pediatric Surgeon
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
OF COURSE, THERE ARE MANY DETAILS THAT CANNOT BE WRITTEN IN THIS TYPE OF DISCUSSION. THANK U SO MUCH FOR TIME & EXPERTISE W/THE ANSWER.
THE MEDICAL EXAMINER SAID THE BLUNT FORCE DRAMA TO THE HEAD IS IN AC-CORDANCE W/CHILD ABUSE & THERE IS NO WAY THE INFANT COULD RECEIVE SUCH A BLOW TO HEAD FROM FALLING OFF BED.
THE AUTOPSY IS NOT COMPLETED AS OF THIS DATE. TOO MANY QUESTIONS & TOO MUCH DETAIL; JUST ASKING BASIC INFO. CAN AN AUTOPSY SHOW POSSIBLE PRIOR BRAIN DISORDERS [SINCE MANY SIGNS OF ABNORMAL ISSUSES WERE PRESENT & REPORTED TO PEDIATRICIAN - IE:ALSO HAD LOTS OF SUDDEN JERKS ALL OVER BODY DURING EARLY MONTHS], DOES IT SHOW ALL PLACES ON BRAIN WHICH MIGHT HAVE BEEN HIT DURING FALL, GENERALLY CAN THE AUTOSY SHOW ALL REASONS FOR CAUSING FALL &/OR THE RESULTS OF ALL HEAD INJURIES CAUSED BY THE FALL.
REFERRING BACK TO FIRST QUERY, INFANT WAS IN MIDDLE OF KING SIZE BED W/PILLOWS STACKED ON THE OPEN SIDE OF BED WAS IN A SOUND SLEEP FOR 30 MINUTES OR SO, AND HAD BEEN LEFT FOR APPROX. 10 MINUTES WHEN A SOUND OF SOMETHING HITTING THE FLOOR WHILE PARENT WAS WALKING TO BEDROOM AND THEN CRYING & SCREAMING.
I AM NOT ASKING FOR ANY LEGAL REASONS OR CRITICISM OF MEDICAL EXAMINER/OTHER M.D.'S. JUST TRYING TO UNDERSTAND HOW AN INFANT W/SUCH UNDERDEVELOPED SKILLS COULD HAVE THIS TRAGEDY & CAN AN AUTOPSY ANSWER THESE QUESTIONS???
THANK YOU & REVIEW BOARD FOR ANY/ALL INFO..
Brief Answer:
Autopsy will efinitely answer many questions
Detailed Answer:
Hi
Greetings
There are many points in the history that point towards possibility of Child abuse
1. Developmental delay: One of the cause that needs to considere is child abuse
2. History of noticing soft swelling in the scalp few days prior to accident: Any unexplained swelling in the scalp with no family history of bleeding one should suspect child abuse
3. From the description: Child in middle of king size bed with pillow at open end, child cannot roll over or sit. Its unlikely that child will fall on its own
If the child has been abused even prior to this attempts, its likely that child could have sustained internal injuries in the brain, chest and abdomen depending on the type of trauma. In an autopsy these injuries can be picked up and based on age of injury it can be assumed to be due to past repetitive injury.
In the brain the following can be signs of past injuries
1. Cerebral atrophy
2. Cotical petechia hemoorhage
3. Sub dural hematoma which has iquified and is in various stage of resolution
4. Hyperostosis or excessive bone in the inner table of the skull.
Autopsy will definitely answer many of the unanswered question and will help finding out past injuries and also age of the injury. From this an inference can be drawn that a child sustained repetitive trauma. Repetitive trauma is likely to be due to child abuse.
Do write to me if you need any further assistance, will be glad to assist you.
Take Care
Best Regards
Dr Deepak Kihsore
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
THANK YOU VERY MUCH FOR ALL ANSWERS. ALL INFO HELPS. THE ROLE OF JUDGEMENT IS NOT MY PLACE.
MANY DETAILS HAVE BEEN LEFT OUT DUE TO THE NATURE OF OUR LIMITED DISCCUSION. BASICALLY THERE WERE 4 CHIDREN (AGES 7MO.,2YRS.,5YRS & 13YRS) THEY HAVE ALL BEEN WITH THE SAME PEDITRICIAN SINCE BIRTH & ALL HAVE KEPT THEIR MONTHLY, 6MO. & ANNUAL CHECK-UPS. THIS INFANT HAS BEEN IN FOR ALL SHOTS, CHECK-UPS & ANY/ALL ILLNESSES AND MOTHER HAS QUESTIONED ALL THINGS THAT SEEMED ODD. THIS INFANT WAS AT DOCTOR'S A COUPLE OF WEEKS PRIOR TO ACCIDENT. ALL CHILDREN INCLUDING THE INFANT HAD REGULAR DENTAL CHECK-UPS. IT IS EXTREMELY DIFFICULT TO SEE THE MOTHER DOING ANY ABUSE OR NEGLECT. ONE GRANDPARENT DID BABYSIT WEEKLY.
THE PEDITRICIAN WOULD HAVE SEEN SOMETHING DURING THESE MONTHS??
UNFORTUNANTLY, THE MOTHER WAS THE ONLY ADULT AT HOME AT THIS TIME. THE OTHER PERSON IN HOUSE WAS THE TWO YR. OLD WHO WAS SOUND ASLEEP.
I MAY HAVE 2 DETAILS INCORRECT IN PAST QUERY!! SINGLE PILLOWS AT HEAD, SIDE & FOOT. INFANT COULD ROLL. DO NOT KNOW WHERE PILLOW WAS AFTER FALL. THE PARENT HEARD A THUD SOUND AS WALKING TOWARDS BEDROOM BEGAN RUNNING, HEARD CRYING, FOUND INFANT NEXT TO CLOSET DOOR CRYING. FURNITURE CLOSE BY WAS NIGHTSTAND, DRESSER THEN CLOSET DOOR.
IT DOES LOOK LIKE CHILD ABUSE IN MANY WAYS!!
WILL AN AUTOPSY SHOW ANY THINGS LIKE DOWNS SYNDROME, EPILEPSY, ETC....??? THIS QUESTION IS MY MAIN QUERY!
Brief Answer:
Down;s syndrome diagnosed by facial appearance
Detailed Answer:
Greetings
If there was Down's Syndrome it would have been easily diagnosed by The pediatrician by typical Down faces and other features.
A baby getting repitetive convulsion is categorized as having Epilepsy. Diagnosis is made from Clinical History and collaborated by Electro-encephalogram (EEG- its only possible when the baby is alive) . Further investigation requires is Magnetic resonance scanning of the brain and in majority of the cases the MRI turns out to be normal or the other findings is atrophy of Corpus collasum which is part of brain. The same thing is possible in autopsy, if the child had epilepsy its unlikely to yield any findings. Its difficult to diagnose if the baby had Epilepsy during autopsy. Certain features like Corpus collasum ( which connects the two Cerebral hemisphere ) could be consistent with possibility of Epilepsy during autopsy.
I am quite sure, an experienced Pediatrician during his examination will be sharp enough to pick up signs of child abuse . Child abuse can occur by anyone including mother. The diagnosis depends on circumstantial events surrounding the incident and autopsy findings and also collaborated with findings of Pediatrician.
Do get back to me if you need any further assistance.
Take Care
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you for all info. I understand anyone can abuse a child. I certainly hope their pediatrician was an excellent doctor.
I do not want to close the discussion permanently yet.
Brief Answer:
Be in touch
Detailed Answer:
Ya very true.
You can keep the discussion open and get back to me anytime or write directly to me.
Wishing you and your family a very happy and healthy life.
Regards
Deepak
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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