title: Child deaths with persistent neglected experiences from medico-legal documents in Japan.
abstract: BACKGROUND
  Few studies have examined the actual conditions of fatal neglect in Japan. The aims of this study were to investigate persistent neglect among child fatalities using medico-legal documents, and to describe the characteristics of the socio-familial background and biological data.
  
  
  METHODS
  The current study analyzed the documents of all postmortem external examinations and autopsies in children <2 years old carried out in one prefecture in Japan from 2006 to 2011. After examining 59 autopsy cases using modified the Maltreatment Classification System, we identified six children who experienced persistent neglect as study samples.
  
  
  RESULTS
  Three children were found in unsanitary rooms and one was left alone inside a car. In two cases, age of mother at delivery was <21 years old. Three victims had 1 year older sibling. With regard to history of use of health services, three mothers missed some prenatal care visits, and two refused to receive neonatal home visits. With regard to biological data the average weight Z score of six children was -2.22 after being adjusted to average weight for age (in months) and sex. Three children had acute or chronic undernutrition. Three victims had thymic involution considered as being due to chronic child maltreatment.
  
  
  CONCLUSIONS
  The present collaboration between public health and legal medicine has enabled investigation of the background and biological impact of experiences of persistent neglect. A multidisciplinary system of evaluating child death is needed to identify preventable factors in order to intervene in the case of neglected children in a timely manner.
authors.affiliation: Department of Health Service Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Yui
authors.initials: Y
authors.lastname: Yamaoka
authors.affiliation: Department of Health Service Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: Nanako
authors.initials: N
authors.lastname: Tamiya
authors.affiliation: Department of Social Medicine, National Research Institute for Child health and Development, Tokyo, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Fujiwara
authors.affiliation: Department of Legal Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
authors.forename: Yukie
authors.initials: Y
authors.lastname: Yamasaki
authors.affiliation: Department of Health Service Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.|Department of Nursing, Ibaraki Christian University, Ibaraki, Japan.
authors.forename: Akemi
authors.initials: A
authors.lastname: Matsuzawa
authors.affiliation: Department of Legal Medicine, Okayama University Graduate School of Medicine, Okayama, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Miyaishi
mesh_terms: D002423:Cause of Death / Q000639:trends; D002649:Child Abuse / Q000331:legislation & jurisprudence / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005554:Forensic Medicine / Q000379:methods*; D006801:Humans; D007223:Infant; D007564:Japan / Q000453:epidemiology; D008297:Male; D008499:Medical Records / Q000331:legislation & jurisprudence*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: autopsy; child maltreatment; child neglect; forensic medicine