Inflicted submersion in childhood
J. M. Gillenwater, L. Quan and K. W. Feldman
Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, USA.
OBJECTIVE: To improve characterization and recognition of inflicted
pediatric submersions. DESIGN: Retrospective case series, records review.
SETTING: A regional children's hospital and the King County (Washington)
Medical Examiner's office. PATIENTS: Children younger than 19 years who
sustained submersion injury between 1983 and 1991 and were hospitalized or
autopsied. OUTCOME MEASURES: Two pediatricians, using preestablished
criteria, categorized abstracted case scenarios as either inflicted or
unintentional events. The two groups were compared. RESULTS: Of 205
submersions, 16 (8%) were judged to have been inflicted. Objective physical
signs of abuse and incompatibilities between the history and the child's
stage of development or physical findings were common (69% and 50%,
respectively). Inflicted submersion victims were likely to be young (median
age, 2.1 years). They tended to be the youngest sibling in a large (three
or more children) household. Social and demographic attributes of inflicted
and unintentional submersion victims did not differ significantly. Bathtubs
were the most common site for inflicted submersions (9/16 [56%]), and
submersions in bathtubs were frequently inflicted (9/34 [26%]). Compared
with unintentional submersion victims, children who were inflicted
submersion victims were less likely to be revived by bystanders (relative
risk, 0.10; confidence interval, 0.01 to 0.72) and were more likely to die
(relative risk, 4.32; confidence interval, 1.40 to 21.43). CONCLUSIONS:
Enough childhood submersions are inflicted to warrant careful case
evaluation. Bathtub submersion victims and children with physical and
historical findings common to other forms of abuse are most likely to be
the victims of inflicted submersion.
