This 6-month-old girl arrived at the medical examiner’s office with extensive destruction of the parietal and occipital skull and partial evisceration of the brain. There are multiple linear abrasions in the forehead as seen (Image 92a). There were also some linear, parallel abrasions on the top of the right shoulder and the upper back. The scene report mentions the child being in a car seat during a motor vehicle accident, but further inquiry and a picture taken at the scene show the damage (Image 92b). The other occupants in the car survived and they were adamant that the child was in the car seat at the time the accident occurred. https://s3-euw1-ap-pe-df-pch-content-public-u.s3.eu-west-1.amazonaws.com/9780429170423/236ca68c-f283-4df8-88b2-3b8ff49bccc9/content/fig92a.jpg" xmlns:xlink="https://www.w3.org/1999/xlink"/> https://s3-euw1-ap-pe-df-pch-content-public-u.s3.eu-west-1.amazonaws.com/9780429170423/236ca68c-f283-4df8-88b2-3b8ff49bccc9/content/fig92b.jpg" xmlns:xlink="https://www.w3.org/1999/xlink"/>

Do you think the child was in the car seat when she was found?

From the scene picture of the car seat, where do you think the child was found? What can you say about how this child was restrained?

What do you think the manner of death should be (homicide or accident)?

It is apparent from the scene picture that the car seat was not adequately fastened to the car’s bench seat by the adult seat belt. The child was not found in the car seat after the collision. Further inquiry revealed that the car seat was simply placed in the car without any actual restraint. Seat belt restraints are very good and are designed not to unlatch unless there is an extreme catastrophic event that essentially means the car is destroyed. The scene picture indicates the V-shaped straps are too close to the back rest for a child to actually have fit in there. When the car seat was inspected, the straps were found to be too short because they were adjusted that way. This child was simply placed on the car seat without being restrained in the seat, and the car seat was not restrained within the car.

This girl was found approximately 30 feet from the car. The car was hit on the side and, as it rotated, the child was ejected through the left rear passenger window, which was open. Had she been properly restrained within the car seat and the latter ejected during the accident, death would still have been a possible outcome but the injuries would not have been as extensive as seen here because the frame of the car seat would have protected the head from injury.

The certification of death in these cases always has controversy. However, infant and child car seats have been around for many years, so arguing ignorance is disingenuous. There are laws that cover the use of infant seats in all 50 states of the United States. This infant would likely have lived if the child seat had been properly latched to the car and the infant in turn properly placed in the seat. 1 A determination of homicide in this case is appropriate. Strictly speaking, homicide is the manner of death used when death is the consequence of the actions of another person. These can be from omission as well as commission. 2