Fatal Starvation/Malnutrition: Medicolegal Investigation from the Juvenile Skeleton

Abstract

Child deaths due to starvation are exceedingly rare and difficult to investigate, and it is difficult to obtain justice for the decedent. These deaths are considered to be the most severe form of maltreatment due to a prolonged period of abuse by the caregiver. Methods used in developing countries to assess malnutrition, starvation, and stunting are presented as they can be useful in medicolegal cases. A case study illustrating the utility of several biological indicators including lines of arrested growth, excessive metaphyseal porosity, growth deficits in long bones, and bone mineral density in medicolegal investigations of fatal starvation is presented. The complexity of these cases calls for multiple lines of evidence such as complete social, medical, and investigative history and investigation in order to rule on a cause and manner of death.