Children and Adolescents 2151 Suicides

Suicide by hanging is rare in children. An Australian study observed that 3.7% of 298 hanging deaths occurred in children 12 yr of age or younger (28). An 8-yr-old male victim was documented in an American study (15). Another study noted a 9-yr-old boy (102). A 7-yr-old was observed in a series from Northern Ireland (50). Scottish and Turkish series showed a minimum age of 11 yr and a male predominance (103,104). Various reasons for children committing suicide include anger toward parents, manipulation to gain love, and a desire to join a dead relative (102,105).

Adolescent suicide victims in various American jurisdictions favored the use of firearms, but hanging was the most frequent method in other countries (106-108).

Various studies have noted that psychiatric disorders, including drug and alcohol abuse, history of suicide threats and attempts, antisocial behavior, and disturbed family structure were common (70,106,107). A note was left in up to one-third of cases. Deaths usually occur at home (106). Most deaths are unwitnessed by adults, but other children can be present in some cases (103).

2.1.5.2. Accidents

A study from Scotland showed a rate of 0.7 accidental hanging deaths per 100,000 children per year (103). Hanging deaths in children aged 6 yr and younger are usually accidental (15). Hangings involving children between 6 and 12 yr of age can be equivocal in terms of manner of death because, at this age, a child may not have the insight into the nature of death (107).

• Child 1 yr old or younger (unable to stand)

° Entrapment of head and neck in crib, baby buggy (see Subheading 3.2. and refs. 15, 28,50, and 109-112).

° Entanglement of clothing in crib (4,28).

° Caught in diaper bag string, elastic strap, pacifier cord, chain (4,43,113-115).

° Suspension from foot of bed/mattress (29).

° Suspension from high chair (4).

° Ligature suspension (e.g., restraining harness or straps in crib or car seat, clothing, pacifier cord, curtain cord, collapsible clothesline, wall light switch strings, looped rope swing [4,15,28,29,48,103,117-121]).

° Neck compressed by upper edge of car window and body suspended (Fig. 6; refs. 4, 122, and 123).

° Neck caught between hinged lid and toy box (114).

Crib deaths include SIDS cases (see Subheading 1.6. and ref. 4). Scene investigation and interviews of caregivers must exclude the possibility of accidental asphyxia. Inspection of the crib determines whether it is unsafe, defective, or hazardous (4).

• Older children (unsupervised [4])

° "Play" hanging (e.g., pretending to be a cowboy); "experimental" behavior (4,15,28, 48,50,103,116,124,125).

° Isolated or repeated acting out for sympathy after punishment or stress (4,125).

° Jumping or playing on bed and suspended by lanyard key, headband (125,126).

° Neck caught between window and window sill (4).

° Suspended from playground equipment (4,48,103,114,127).

° Physically handicapped child caught in a restraint (see Subheading 2.1.4. and ref. 4).

° Autoerotic asphyxia (see Subheading 2.7. and refs. 4,43, and 48).

Because of the lack of adult supervision, all unnatural manners of death must be considered (Fig. 7).

Death Partial Hanging Images
Fig. 6. Accidental suspension death. (A) Young girl found suspended on outside of car with her neck wedged between edge of partly open window and A-pillar. Fingerprint smudges on window. (B) Partial neck furrow.

2.1.5.3. Homicides

Some examples reported in the literature include:

• 8-yr-old female found hanging in open area (7,28,103).

• 4-yr-old female suspended from a doorknob (128).

Sexual assault must be considered under these circumstances (7,28,43,103).

Death Partial Hanging Images

Fig. 7. Hanging death of undetermined manner. (A) Young boy found suspended, under suspicious circumstances, from a coat hook on the toilet stall door in the washroom at his school. (B). Survival in hospital for several days. Severe hypoxic-ischemic encephalopathy. Abrasions (arrows) on posterior scalp were not from the coat hook but from friction from a cervical collar.

Fig. 7. Hanging death of undetermined manner. (A) Young boy found suspended, under suspicious circumstances, from a coat hook on the toilet stall door in the washroom at his school. (B). Survival in hospital for several days. Severe hypoxic-ischemic encephalopathy. Abrasions (arrows) on posterior scalp were not from the coat hook but from friction from a cervical collar.

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