UNLABELLEDNo reliable data are available on cases of lethal child abuse (by active force) in the area of Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany.RESULTSThe study center received information on 58 cases of lethal child abuse. Extrapolated to all institutes of legal medicine, this corresponds to 62 cases in all of West Germany in the period studied. An approximately equal number of unreported cases should be added to this figure. Including unreported cases, at least 20 cases of lethal child abuse occurred per year; thus only one in every two cases ever came to light. Almost two thirds of the victims were younger than one year old. At autopsy 59% exhibited signs of repeated abuse at autopsy. By far the most common cause of death was direct impact from a blunt object, usually to the head. Mostly, the male person to whom the victim relates most closely (father, stepfather, partner of the mother) has killed the child. Twenty-one of the 74 persons charged saw the charges against them dropped or were acquitted due to lack of evidence; 51 received sentences ranging from one year probation to life. In the remaining two cases the outcome of the trial was unknown. Signs of abuse were readily apparent at autopsy in almost all cases. The high number of unreported cases underscores the need to educate medical students and practicing physicians to be on the look-out for signs of abuse and argues for an increase in the rate of autopsy.

UNLABELLED:Up to now reliable data were available on cases of lethal child neglect in the area of the Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period from 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany.RESULTS:The study center received information on 19 cases of lethal child neglect. Extrapolated to all institutes of legal medicine, this corresponds to 20 cases and thus 3.5 cases a year in the whole of West Germany in the period studied. There is to be added a dark-field which cannot be limited more precisely. However, the cases of fatal child neglect might have occurred much more seldom than fatal child abuse caused by use of physical violence. Slightly more than half the victims were younger than 1 year, the oldest one was 7 10/12 years old. Most frequently the children died of starvation and thirst. Mostly the mothers/nursing mothers killed the child alone or together with the victim's father/stepfather. In the majority of the cases there was not a close affection between parents and child. Nearly 30% female/male perpetrators suffered from chronic alcohol abuse. Only 15 (= 56%) of 27 female/male perpetrators were sentenced to imprisonment (period between 7 months on probation and 10 years). Mitigation circumstances existed for nearly half the persons sentenced to imprisonment. It is true that child neglect is a rarer crime, but the experts of legal medicine always have to indicate errors made during the external inspection of the corpse (among others failures to see indications of neglect).

Nach der Todesurachenstatistik betrug die Inzidenz des plötzlichen Kindstodes von 1985 bis 1989 in der Bundesrepublik 1,55 Fälle pro 1000 Lebendgeborene (1,51 bis 1,59). Es liegen jedoch bisher keine Angaben über die Obduktionsfrequenz vor. Deshalb wurden rechtsmedizinische und pathologische Institute mit der Bitte angeschrieben, mitzuteilen, bei wie vielen Säuglingstodesfällen in der Zeit von 1985 bis 1989 nach der Obduktion die Diagnose eines plötzlichen Kindstodes gestellt wurde. Alle angeschriebenen 53 rechtsmedizinischen und 81,1% der 376 pathologischen Institute teilten uns die Obduktionszahlen mit, die mit den Angaben der Todesursachenstatistik verglichen wurden. Dabei ergab sich eine Obduktionsfrequenz von 55,2% mit nur geringen jährlichen Schwankungen (51,1% bis 59,3%) und erheblichen Unterschieden zwischen den einzelnen Bundesländern. Die höchsten Obduktionsfrequenzen wurden in den Stadstaaten Berlin (West) und Hamburg erreicht. Bei den Flächenstaaten wies Niedersachsen mit 77,8% die höchste Obduktionsfrequenz auf, während in Rheinland-Pfalz von allen Bundesländern die niedrigste Rate mit 20,1% zu verzeichnen war. Sowohl unter wissenschaftlichen, forensischen und ärztlichen Aspekten sollte die Obduktionsfrequenz bei plötzlich verstorbenen Säuglingen in Deutschland erhöht werden.