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February/March 2002Vol. 3, No. 2Overlaying with Bruises/Abrasions Indicates Possible Abuse

A recent study of infants who suffocated after "overlaying" offers insights for investigators of child fatalities.

"Overlaying" refers to instances when a larger, sleeping individual rolls on top of an infant, causing the baby to smother. The study found that infants smothered by overlaying rarely have cuts or bruises; conversely, the presence of cuts or bruises on the body of a smothered infant could indicate that the baby was a victim of abuse.

Dr. Kim Collins, associate professor of forensic and autopsy pathology at the Medical University of South Carolina in Charleston, reviewed the 32 pediatric forensic cases referred to the Medical University of South Carolina Forensic Pathology Section/Charleston County Medical Examiners' Office from 1985 to 1999 specifically to determine if these traumatic characteristics were present in overlaying, wedging (child wedged between two objects such as a mattress and a wall), and other accidental asphyxiation.

Dr. Collins reports that pressure marks from bedding or the other person's clothing may be seen on the infants, and can occur after death; this differs from contusions. Contusions, abrasions, and other traumatic injuries like facial or ocular petechiae (small red or purple blood-filled spots on face or eye caused by a minute hemorrhage) require greater pressure than overlaying or wedging produce.

It is estimated that in half of American families, a family bed is shared with an infant. Dr. Collins states that in order to prevent overlaying and wedging, unsafe sleeping arrangements need to be further explored.

Dr. Collins' study can be found in the American Journal of Forensic Medicine and Pathology (22(2): 55-159, 2001).

Related Items

See the following related articles in these past issues of the Children's Bureau Express:

  • "OJJDP Fact Sheet Highlights National Center on Child Fatality Review" (July/August 2001)
  • "Pediatricians Urge Closer Scrutiny of SIDS Cases" (May/June 2001)