In the early afternoon an emergency call is received requesting assistance for an unresponsive 13 month old child, and paramedics are dispatched. The child was in good health and had been behaving and reacting normally when last seen by her parents at approximately 9 am. During the day, she was in the sole custody of a 17 year old in-home caretaker, who had been living with the child's family for the past 10 months. The child was apneic and unresponsive when the paramedics first arrived but was resuscitated and taken to a local hospital. At the hospital, a head CT scan reveals a subdural hematoma with cerebral edema.
Funduscopic examination reveals bilateral retinal hemorrhages.
A body radiograph reveals a fracture of the upper right humerus. The child died two days after admission. Upon questioning, the caretaker reported that she was changing the child's diaper on a table when the child suddenly arched her back and fell off the table, landing on her head. Investigation of the scene reveals that the surface of the table is 74 centimeters above the floor. The floor is concrete but covered with carpeting and an underlying carpet pad.