Griest K J, Zumwalt R E
Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque 87131.
Pediatrics. 1989 Jan;83(1):41-6.
Drowning as a form of subtle fatal child abuse is difficult to distinguish from accidental immersion or from sudden unexpected natural death when the circumstances of immersion are concealed. Homicidal drownings are unwitnessed, usually occurring in the home, and the victims are young, either infants or toddlers. Accidental drownings are more likely to involve toddlers or older children in public areas such as swimming pools, drainage ditches, lakes, and rivers. This is especially true in rural areas. In cities, bathtubs remain a major site of accidental childhood drownings. Perpetrators of deliberate drownings often fit the sociopathologic profile of a child abuser. Because there is often a survival interval between immersion and death, pathologic findings consistent with postimmersion syndrome suggest the cause of death. Foreign material in the lungs, if immersion was other than in clear tap water, and injuries of the face are other positive correlating factors. A thorough investigation of the circumstances and cooperation between the investigating agency and the pathologist are essential to determine the correct manner of death in these cases.
溺水作为一种隐蔽的致命儿童虐待形式，当溺水情况被隐瞒时，很难与意外溺水或突然意外自然死亡区分开来。他杀性溺水事件无人目睹，通常发生在家中，受害者为幼儿，即婴儿或学步儿童。意外溺水更有可能涉及在公共区域（如游泳池、排水沟、湖泊和河流）的学步儿童或大龄儿童。在农村地区尤其如此。在城市，浴缸仍然是儿童意外溺水的主要场所。故意溺水的肇事者往往符合儿童虐待者的社会病理学特征。由于从溺水到死亡通常有一段存活期，与浸没后综合征相符的病理发现提示了死亡原因。如果溺水不是在清澈的自来水中，肺部有异物以及面部受伤是其他相关的阳性因素。对情况进行彻底调查以及调查机构与病理学家之间的合作对于确定这些案件的正确死亡方式至关重要。
