Study Of 12 Starved Children Indicates That Parents Targeted and Abused Them, And That the Younger the Child the More Likely They Were To Die From The Effects.
A recent study, Criminally Prosecuted Cases of Child Starvation1, examined 12 cases arising in Texas between 1991 and 2003.
Court documents, photographs, medical records, depositions, testimony, and investigative reports were reviewed from the cases. The median age of the children was 2.7 years and the range was from 2 months old to 13 years, 7 months old. Six children survived. Five were dead at the time of presentation, and one child died 13 days after being resuscitated from shock. All the deceased children were autopsied and the results were used as part of this study. Clinical, social, and legal findings were reviewed and compared.
Medical and Psychological Factors:
Age was the only statistically relevant risk factor for death resulting from the starvation. The younger the age of the children, the more at risk for death they were. Stunting (decreased height and weight for age), wasting (normal height, but decreased weight for age) and severe psychological distress were observed. Medical issues involved brain atrophy, bezoars (balls of foreign materials in the digestive tract, often caused from gnawing on indigestible objects such as hair), enlarged livers, distended abdomens, edema (swelling), lack of subcutaneous fat, skin lesions, low blood nutrient levels, and dehydration. Behavioral symptoms included hoarding, distrust of hospital personnel, rummaging through garbage, and stealing food. These symptoms were often accompanied by evidence of recent physical or sexual abuse. Re-feeding complications manifested in gastric problems, diarrhea, hyperglycemia, and fluid overload shown by edema or congestive heart failure.
The parental histories were characterized by minor complaints about their children’s behavior or unusual eating habits, as well as a lack of acknowledgement of the child’s poor condition. In all but one case, other children in the home were not malnourished and food and healthcare were available. Parents of the older children justified withholding food as punishment for various behaviors such as ADHD, the ineffectiveness of corporal punishment, and even perceptions that the child was evil. Often, the parents adequately fed the other siblings and admitted to keeping the starved child secluded and restrained from food. In the presence of other people, such as investigators, the children were often covered in clothes or blankets which hid their obvious weight loss.
Legal and Investigative Outcomes:
Five of the children had been previously reported to CPS for various types of abuse allegations. For all cases that went to trial, photos of the victims, readily available food at the residences, and other non-starved siblings and adults in the household, were shown to demonstrate that the parents had knowledge of how to keep the children fed. Testimony emphasized that reasonable adults would recognize the children’s poor condition. Defense arguments focused on lack of resources, undetected genetic disorders, or eating disorders. Genetic and eating disorder arguments were countered by observations of the children’s ravenous appetites and sustained weight gain after rescue. Lack of resources arguments were countered by showing food in the household and previous doctor visits by siblings and the victims themselves.
Parental rights were terminated in all cases. The most common criminal charge was “injury to a child by omission.” Twenty-three of 25 defendants were found guilty or pled guilty to the charges. Life sentences were given to 5 individuals.
Finally, the study emphasizes that protecting the survivors and the siblings from future harm is an important medical goal. Clinicians must therefore accurately communicate the severity of the findings to CPS, law enforcement investigators, and attorneys.
Nancy Kellogg, MD, and James L. Lukefahr, MD, Criminally Prosecuted Cases of Child Starvation, PEDIATRICS, Vol. 116, No. 6, December 2005 1309 – 1316
