Wedging Death by Interposition

Wedging is a form of mechanical asphyxia in which the face, neck, or thorax is compressed between two firm structures (see Subheadings 3.7. and 3.8. and ref. 27). Adults can become wedged between a bed rail and mattress (see Subheading 2.1.4. and refs. 99 and 332). In a review of 2178 infants younger than 13 mo of age dying of mechanical suffocation in the United States from 1980 to 1997, wedging was the most frequent scenario (40%), followed by oronasal obstruction or smothering (24%), overlaying (8%), entrapment with suspension (7%), and hanging (5% [117]).

Young children, aged 3 mo to 2 yr, are usually found in an adult bed or their own crib/bed (117). One study showed that wedging was seen primarily in 3- to 6-mo-old children (117). At this stage, infants have the capability to move to the corners of beds and cribs, but they do not have the muscle development to be able to extricate themselves out of a wedged position. They become wedged between the mattress and

Fig. 55. Wedging. (A) Infant found wedged between the bed and wall. Child also suffered severe burns from malfunctioning electric baseboard heater. (B) Indentation on scalp from edge of bed. (C) Reflected scalp showing associated contusions.

either the wall, bed frame, a piece of furniture, mesh, or another mattress (Fig. 55; refs. 4, 27, 35, 111, 113-117, 302, and 303). Parents may believe that pushing a bed against a wall prevents a child from falling out while sleeping. Heads wedged between crib slats or bedrails is another scenario (27,113-115,302). A defective or malfunctioning cot is a possibility (see Subheading and ref. 117). The mechanism of death in these cases could be aspiration (110).

Few external findings are seen; this emphasizes the importance of scene investigation and interviews. Some cases show facial contusions or abrasions (27). Linear marks and indentations on the scalp and neck are consistent with contact with a firm surface (e.g., edge of bed frame; see Fig. 55 and ref. 27). Facial petechiae are rare, in contrast with adult traumatic asphyxia cases (27). No oral injuries are observed. Finding multiple cutaneous and oral injuries heightens the suspicion of nonaccidental asphyxia (27). A minority of cases have intrathoracic petechiae; usually only a few are present (27).

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