Homicidal abuse of young children: A historical perspective

The past 50 years has seen a heightened awareness of abusive injury patterns and increased concern for the plight of children victimized by their caregivers. Murder of the young, however, has been embedded in society since the beginning of recorded time. Indeed, nature provides abundant examples of infanticide in lower animals, raising the question of whether exploitation, apathy, and violence toward children are on some level evolutionarily conserved. In human antiquity, selective killing of females, the illegitimate, and the malformed, killing by ritualistic sacrifice or to conserve resources was carried out with impunity. The middle ages and later saw a decline in these practices albeit limited. One hundred years into the industrial revolution, with harsh child labor in public view, legal remedies were sought to protect children but with little effect. The domestic abuse of children was not addressed until a pivotal 19^th-century case, in which the rights of animals were invoked to intervene on behalf of a child. In the 20^thcentury, physicians began to look closely at anatomical findings; patterns due to trauma, especially inflicted trauma, began to emerge. 'Battered child syndrome' was followed by 'shaken baby syndrome,' the latter prompted by the recurrent findings of subdural hematoma, retinal hemorrhages, and brain injury with the absence of impact injuries and no plausible accidental or natural disease explanation. In the 21^stcentury, high-quality studies and an emphasis on evidenced-based medicine substantiated the existence of injury patterns resulting from homicidal violence. However, progress has been uneven. A case of child abuse that reached the US Supreme Court resulted in an ill-cited dissent that seems to have amplified an already toxic medicolegal environment, perhaps unjustifiably. The difficulties in balancing the welfare of society with that of caregivers in the aftermath of homicidal abuse will no doubt continue.