Every other month, a Norwegian child dies as a result of neglect, abuse or murder. The last ten years have nearly 60 children under 4 years passed away in this manner.
The sun is about to set over the National Hospital in Oslo. Autopsy hall is burnished and sterile. Sometimes doctors keep going long into the night there.
Sometimes they have an unpleasant suspicion that the death may be due to a physical assault.
About 40 times a year is the Norwegian children in this or similar venues. Often, the children's parents who have robbed them of life.
Dies before the first birthday
Each year lose between six and ten children under 4 years life in Norway as a result of homicide, abuse or neglect from the closest, most often parents.
If you include all children up to 18 years, the number doubled, but in older children constitute a larger share of accidents. Four children between 5 and 18 years are victims of homicide annually.
Severe physical abuse usually affects the very least. Many people who die have not been able to celebrate their first birthday. This has been true throughout the 2000s, and in the decades before.
Child abuse seems to have increased
The startling figures confirmed by coroners, police, researchers and the Ombudsman.
The incidence of child abuse appears to have increased in the past decade. This could, according to experts, due to better inform practices and increased awareness of the problem.
in 2004, it reviewed 342 cases of possible violence against children under 12. In 2009 the figure had risen to 957
Abuse of children has been prohibited by law in Norway since 1987.
Recent studies show small variations in the western world. Norway is therefore no better than others, confirms Professor Torleiv Rognum the Institute of Forensic Medicine, National Hospital, one of the most experienced forensic experts.
He meets us, dressed in green, behind the big autopsy table in steel. How has Rognum been many days and nights, weekends and holidays. Right behind him, the door to the cold room to keep the bodies cold.
For the moment there is no child there. But no one knows what tomorrow brings. The only Rognum know for sure is that it's going to be worn in more children in this room.
There has been a 7 weeks old baby with 18 older rib fractures, a baby who was strangled with a bottle to his mouth and a 1-year-old with a fractured skull.
Therefore children die
About 40 infants and toddlers under 4 years of age die suddenly and unexpectedly each year. This is an annual average of the last 10 years:
15 die of SIDS (about 40 percent of deaths annually)
16 die of disease
6 die of accidents
1-2 dies of neglect
2 die from abuse
1-2 are killed
Source: Public Health
- The most frequent injuries due to gross child abuse caused by shaking - often with blunt instruments such as dunking of the head against a table. It is difficult to comprehend how violent parents and other adults may be against their children, says Rognum.
- But we must dare to think the thought that it's the parents who are the culprits.
Sure of his case
Down in the basement of the hospital's autopsy benches clear in three adjoining rooms. In there shines no sun.
We currently professor of better equipment, including a CT scanner, which can help to determine the cause of death. It is partially funded by the private Stine Sofie Foundation.
Many times over nearly 30 years Rognum come out at all hours to autopsy a dead child.
Sometimes he thought: This child is killed. There is no doubt. Yet it is far from always that his suspicions lead to prosecution or conviction.
- It's frustrating to be sure unless it can be proved, says the professor.
He has spent much time in court, including Christoffer case and Baneheia case. In several cases - that he will not mention by name - he's been amazed arcane acquittals.
Will visit all the homes
When a child dies a sudden and unexpected death, it shall be autopsied. It is mandatory. But parents can choose whether they want a death scene investigation in the home.
- Child neglect may go undetected if the parents refuse, warns professor Torleiv Rognum.
On the other hand, from 1 July 2011 the police were obliged to investigate all sudden deaths in children under 18 years. Thus, some families will be visited by police and coroners twice after such a tragedy.
- It is important to remember that in the vast majority of cases the parents are innocent. A thorough examination is a good thing for families who experience losing a child. It shows that their child was much worth, and that prevent gossip and suspicion. I think that the death scene investigation should also be mandatory, says Rognum.
So far this year, two Norwegian families declined to such a death scene investigation in the home.
Must remove taboo
Some parents choose to bring their child to her death by suicide in the belief that it would be best for the child. Others choose to kill the child when they lose visitation rights with the child.
- We must not be blind to the Norwegian parents can do something as terrible as killing their own children, says researcher and criminologist Vibeke Ottosen.
She has conducted research on child killings in Norway. The similarities with other countries is huge: There are close caregivers who kill children. Most often, a mother, a father or a step-parent.
- Many people are overwhelmed by being a parent. There is a greater challenge than the powers, says Ottosen.
Some infanticide occurs without any warning, either violence or abuse. Other occurs as a result of it. The smaller the child, the greater the risk of infanticide.
See the same trend researcher with maternal age. Young mothers increases the risk.
Dead in the sledge
Professor Rognum have seen many cases of neglect. He does not forget the three-month old girl was tore into the thick clothes, lots of blankets and placed in the bed close to the heater.
18 hours later she was found dead.
Or the family that was going on pulktur but had forgotten the bag to the child in 10 degrees below zero. They made rather a makeshift packaging, but forgot to look at the girl frequent enough that little hour trip lasted.
She was found dead at the bottom of the sled when the tour was over.
Many cases of infanticide is probably due to lack of care for the child after birth.
The mother then tend to claim that she thought the child was dead, and that she let it be insufficient covered in weather, wind and cold. Newborns can die within hours that way.
- Women who kill their newborn children, have often sought to keep the pregnancy and birth secret, says Torleiv Rognum.
- Such killings were frequent before. Now we may be one such case a year or even less frequently. It is probably due to it being a single mom is widely accepted today.
Recovering at home
Each year studying Norwegian pediatricians nearly a hundred cases of suspected serious physical abuse of children under 14 years, according to a report from the National Research Centre for Violence and Traumatic Stress in 2010.
Ombudsman for Children and physician Anne Lindboe have contributed to this report. She has worked for many years with the theme of violence against children.
In his time as a doctor, she was repeatedly involved in autopsies of young children who had lost their lives due to parental violence.
- It does something to you when innocent children can not be safe in their own home. Here is the big unknown, confirms the ombudsman.
In her report, "Detecting child abuse hospitals?" Shows that domestic violence is not a rare phenomenon in our society. The extent of the physical abuse of younger children from their parents or caregivers are not mapped in Norway or Scandinavia.
- In studies of children examined for injuries at a hospital or emergency, there is reason to suspect abuse in one to eight percent of the cases, said Lindboe.
Christoffer case was an eyeopener
Christoffer case has been a wake up call for the nation. In this case was convicted of killing his stepfather and mother of complicity. Still think the professionals who work with children killing and abuse that we are naive in Norway.
Former head of the pediatric department at Ullevaal Hospital, Jens Grøgaard, is one of the nation's foremost experts on damages for child abuse. He now works for the Children Museum in Oslo and is an expert witness in cases involving violence against children.
- Children have for many years suffered badly due process. In a research and investigation phase, I believe the safety of the child must outweigh considerations caregiver says Grøgaard.
Noones cuddle toy
He is supported by Torleiv Rognum, who notes that children are not adult toys. Doctors have long believed that the confidentiality of adults have weighed heaviest.
- Fortunately, the line on the wane, says Jens Grøgaard.
- Even if we manage to capture the children who die of abuse, it is not always that children who survive severe abuse, coming into contact with the health care system.
Grøgaard emphasizes that infants, according to recent research, may develop cognitive damage of being with an abuser.
- The child may develop psychological late effects if the brain does not develop normally for the first year. It does not work if a child is the victim of neglect or abuse. The result may be conditions like ADHD, violent aggression and anger.
Every time a child dies, there shall be autopsied. Institute of Forensic Medicine receives notification from paediatricians or the police when this occurs.
A funeral're driving with your child as soon as possible after death, and the team to conclude the cause of death, is summoned. An autopsy will take place within 48 hours.
Scientists at The Institute have studied the circumstances and legal supervision of infanticide aged 0-4 years in Health Region Southeast back to 1970.
Although the study was approved by the Regional Ethics Committee, Office of Attorney General and Justice Advisory Council for Ethics in Research, Data Inspectorate has stopped the study of privacy concerns.
Typical of physical punishment
After the war was corporal punishment common in both homes and public institutions.
In Norway, the prohibition against the use of violence against children included in the Children Act in 1987 (Act on children and parents).
- Sometimes reports from police about a suspected murder or fatal maltreatment. Other times we have no idea anything about what might have killed the child, says Rognum.
Two doctors autopsy, in addition, a technician, an engineer and a police expert always present.
- We take X-rays, CT and MRI, all tests imaginable of relevant bodies, to find hereditary and congenital defects. We follow a comprehensive protocol and have a conference to end. All stones are turned around in pursuit of the cause of death. It deserves the kids, says Rognum.
He admits that not all forms of killing is as easy to detect. Especially in children under 1 year.
Shaken to death
Every year, 10 to 12 babies severely damaged by shaking, known as shaken baby syndrome. Every third die as a result of the injury, third gets permanent brain damage, while a third survived unharmed.
This is an estimate calculated from cases recorded in health care and international research.
In Stavanger was recently a two-month-old boy hospitalized with serious injuries, including skull fractures. Doctors warned that the injuries were consistent with shaken baby syndrome.
At the very least it's head injuries are the most severe, and the child can be damaged for life or die by it. We have seen examples of several times, also in Norway.
- In Scotland and the United States have found that date. 100 000 children under 1 year will be placed 24 to 29 such injuries annually. 19 percent of serious head injuries in children under 3 years is likely due to abuse, concludes a study from Ullevaal Hospital and the Norwegian Centre for Violence and Traumatic Stress (NKVTS).
- Suffered head injuries and often severe brain injury with severe disability, says Anne Lindboe.
- The serious injuries encountered in hospitals, is probably just the tip of the iceberg. The outcome can be tragic when something is detected. The danger that the violence escalates, it is great.
More home visits
But what can be done to ensure that more cases of severe violence against children is discovered - and the guilty punished?
- We need to stop letting it be taboo to think that parents can stand behind the violence. Good economics does not increase security for the children. Stressed parents with little time can be a risk factor. The risk exists in all walks of life. I've unfortunately many examples of, say Grøgaard.
- Each time the child to be hospitalized, it should be mandatory for physicians and other health professionals to write in sick journal about suspected child abuse. Prevention is also important: Everything from several home visits by nurse for interdisciplinary teams that investigate if there is suspicion of child abuse.
In many cases you have to have experience to reveal the violence. Bruising in young children, especially those who can not walk yet, must be checked. Neighbors, school and environment must say so. Everyone has a responsibility.
- Police skills must be strengthened. They must know what to look for, and it has introduced mandatory death scene investigations when children die, think Grøgaard.
Torleiv Rognum have seen it. It takes a lot to shock the professor - but little to touch him.
- It's bad every time a child dies in this way. When I necropsied, I try to concentrate maximum. It often happens - when we get young children with obvious damage of abuse - that some in attendance crying, he said.
- And it's all natural.