“MEDICO LEGAL IMPORTANCE OF AGE ESTIMATION”

SCHOOL OF LAW

MANIPAL UNIVERSITY JAIPUR

IN PARTIAL FULFILLMENT OF THE REQUIREMENT PRESCRIBED

FOR BA. LL.B (HONS.) 7th SEMESTER

UNDER SUPERVISION OF- SUBMITTED BY-

Dr. V. N Mathur Mamta (VII Semester)

Professor 151301057
B.A. LL.B (Hons)
 CERTIFICATE

This is to certify that Ms. Mamta student of B.A. LL.B (Hons.) seventh semester, School of Law
Manipal University Jaipur has completed the project work entitled “Medico legal importance of
age estimation” under my supervision and guidance.
It is further certifying that the candidate has made sincere efforts for the completion of the
project work.

Supervisor Name
Dr. V.N Mathur
Professor
 ACKNOWLEDGEMENT

This is not just a customary acknowledgement of help that I received but a sincere expression of
gratitude to all those who have helped me complete this project and made it seem apparently
more readable than otherwise it would have been.

I am in debt to my faculty advisor DR. V.N Mathur for giving such an interesting and
amazing topic ‘Medico legal importance of age estimation’ and making it seem easy by lucidly
explaining its various aspects. I would like to thank him for guiding me in doing all sorts of
researches, suggestions and having discussions regarding my project topic by devoting his
precious time.
I thank department for providing Library, Computer and Internet facilities. And lastly I
thank my friends and all those persons who have given valuable suggestions pertaining to the
topic and have been a constant source of help and support.

Thanking everyone,

Mamta
 TABLE OF CONTENTS

INTRODUCTION ........................................................................................................................................ 5
FORENSIC AGE ESTIMATION ................................................................................................................. 6
Civil Cases .................................................................................................................................................. 10
Criminal cases ......................................................................................................................................... 10
Ages of Medicolegal importance ................................................................................................................ 11
Medicolegal importance of 1 year of age.................................................................................................... 11
Medicolegal importance of 2 years of age .................................................................................................. 11
Medicolegal importance of 3 years of age .................................................................................................. 11
Medicolegal importance of 4 years of age .................................................................................................. 12
Medicolegal importance of 5 years of age .................................................................................................. 12
Medicolegal importance of 6 years of age .................................................................................................. 12
Estimation of age from X-rays .................................................................................................................... 12
Age from Sternum....................................................................................................................................... 13
Age from femur and hip bone ..................................................................................................................... 13
Age from foot bones ................................................................................................................................... 14
 INTRODUCTION

The reconciliation of skeletal and chronological age is of paramount concern in the context of
criminal proceedings involving living individuals, who frequently lack any associated
identification documentation, and are referred to the criminal justice system. It is important to
appreciate that skeletal and chronological ages are not the same measurement of time-since-birth,
and depending on the analytical approaches applied, there will be an inherent source of variation
between estimated (biological: skeletal, physical, and psychological) and actual (legal) age.
Given the evidentiary value attached to the estimation of age based on the subjective assessment
of biological and psychological developmental attributes, it is timely to consider current
approaches toward achieving the latter. The aim of this review is to first explore a selection of
circumstances that result in requests for forensic age assessment in living individuals. Issues
pertaining to competency to perform an assessment, sources of error that may be introduced, and
how to accordingly quantify the level of uncertainty in the final estimation are then considered.
This logically leads into discussions of the necessity for population-specific statistical biological
data. Current methods based on psychological development, dental status, and skeletal
maturation are then reviewed. The review concludes by exploring future research and practical
directions in the context of medico-legal practice and social consequences.

The work of forensic scientists and allied professionals is wide reaching and important; these
practitioners are holders of a public trust because a portion of the vital affairs of other people is
placed into their hands by virtue of their role in the medico-legal system. This is perhaps most
poignant when a forensic practitioner is requested to perform an assessment of age in a living
individual for the purpose of providing information that carries significant evidentiary value in
legal decisions that determine future outcomes for individuals displaced from their original
homeland. This review considers some of the more common circumstances that result in living
individuals without documentary evidence of identity (and thus age) entering the justice system.
It also discusses who should be deemed qualified to perform the requisite assessment(s), and the
processes of selecting an appropriate method(s). The review concludes with some consideration
of future directions in the discipline.
 FORENSIC AGE ESTIMATION

Legal requirements for age estimation in the living Refugee and asylum seekers A proportion of
the world’s population is presently in a state of involuntary flux resultant from displacement by
war, internal conflict, or natural disasters. According to the United Nations High Commissioner
for Refugees (UNHCR), almost half of people forcibly displaced from their homes are children,
representing a demographic at particular risk of “abuse, neglect, violence, exploitation,
trafficking or forced military recruitment”1 and in need of international protection. The
Convention on the Rights of the Child (1990) has been signed by 193 of the 195 United Nations
(UN) member nations. It stipulates that States Parties shall respect and ensure the rights of each
child within their jurisdiction without discrimination; a child is defined as being ,18 years of age,
which places the onus on member States to protect children in their jurisdiction. A particular
difficulty arises, however, when individuals claiming to be children have no legitimate identity
documentation to evidence their assertion. The UNHCR Guidelines on Policies and Procedures
in Dealing with Unaccompanied Children Seeking Asylum (1997) advise that if chronological
age is uncertain, an unidentified child should be given the benefit of doubt, and that requisite age
assessments should accordingly consider whether “an individual demonstrates an ‘immaturity’
and vulnerability that may require more sensitive treatment”. The guidelines propose that age
assessments should be based on a combination of criteria, including physical appearance and
psychological maturity. Any scientific procedures should facilitate the quantification of
uncertainty (margins of error) and be in accordance with the ethical treatment of children2 – both
safe (eg, minimally invasive – both physically and in relation to minimizing deleterious radiation
from any medical imaging) and respectful of human dignity.3,4 UNHCR Detention Guidelines
(2012) refer to asylum seekers as persons applying for refugee status (Article 1 of the
Convention relating to the Status of Refugees (1951), amended by the 1967 Protocol: A person
who owing to a well-founded fear of being persecuted for reasons of race, religion, nationality,
membership of a particular social group or political opinion, is outside the country of his
nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of
that country; or who, not having a nationality and being outside the country of his former
habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to
return to it) as well as other persons seeking complementary, subsidiary, or temporary forms of
protection. The guidelines recommend that children (in particular) should not be detained while
seeking asylum, and serve as a reminder that minors have the right to not be separated from their
parents against their will.5 For receiving authorities (governments and decision makers), this
presents substantial logistical implications, as there is no guarantee of compliance with non-
separation. Australia, for example, has a mandatory detention policy,6 and in 2014, a total of 983
children were held in immigration detention facilities, either in Australian territories or in Nauru
(South Pacific island nation hosting detention centers to process asylum seekers and refugees
arriving in Australia by boat) for an average period of 231 days.7 From a humanitarian
perspective, the detention of minors is a serious and real concern, as teenagers are particularly
susceptible to mental and emotional distress, which can lead to self-harm.7 However, separation
of those minors from their immediate families, which could occur if erroneously deemed to be
legally an adult, would arguably be worse. Child asylum seekers, and children left behind by
families seeking asylum, are particularly vulnerable to human trafficking, whether on-route to
their new destination, while in detention awaiting processing, or after relocation in an unfamiliar
environment.

Human trafficking The UN Protocol to Prevent, Suppress and Punish Trafficking in Persons,
especially Women and Children (2000) definition of human trafficking implies the exploitation
of a person by means of the threat or use of force.9 The most recent reports state that trafficking
victims were identified in 124 countries (2010–2012) and are thus considered a global issue. A
total of 160 member States ratified the Trafficking in Persons Protocol, with 90% of members
criminalizing trafficking in persons. Such legislation is presently nonexistent in nine countries,
with an additional 18 others having some form of legislation, albeit inadequate to offer the
protection required; as a result, it is estimated that, as of 2014, more than two billion people are
not fully protected by the Trafficking in Persons Protocol.10 Detection of trafficking victims is
increasing, as is the ratio of child victims relative to adults, particularly in Africa and the Middle
East.11 On average, one in three trafficking victims is a child, which represents an increase of
5% from the previous study period of 2007–2010.10 From information reported by 80 countries
encompassing the period 2010–2012, 31,766 trafficking victims of known age and sex were
identified; 12% of those were boys, and 21% were girls, all ,18 years of age.10
There are a variety of motivations for people trafficking, including: sexual exploitation; forced
labor in, for example, catering, domestic servitude, textile production, construction, forestry,
mining, and agriculture; adoption; forced military recruitment; begging; and organ
harvesting.10,12 Reported transnational trafficking usually involves victims from less developed
countries, from regions including South and East Asia, Central Europe, sub-Saharan Africa, and
South America. It is also known that trafficking occurs in more developed countries, including
North America and in Western and Central Europe, and the Middle East. Domestic trafficking is
common, and often more widespread than the international movement of people; again, the flow
of people is usually from poorer rural areas to richer urban environments.8 Children from low
socioeconomic backgrounds are vulnerable to trafficking, fueled by the demand for cheap labor,
young brides, prostitution and pornography, and clandestine adoption.8,13 Once trafficked,
children are often required to engage in criminal activities, thereby instigating their admission
into the local punitive system, often in the absence of, or with, falsified identity documents.

Criminal responsibility The age of criminal responsibility in much of the developed world is 10
years (eg, Australia, New Zealand) but is as young as 7–8 years (eg, India, Jordan, Indonesia);
children under this age cannot be arrested or charged with a crime. A more controversial concept
is that of doli incapax, which is the presumption that a child is incapable of committing a crime
under legislation or common law and applies to children, generally in the age of 13 years (eg,
New Zealand) or 14 years (eg, Australia), depending on jurisdiction.14–16 The UN published
guidelines to the effect that no children “under the legal age of criminal responsibility should be
subject to criminal charges” and is openly critical of nations with an age of criminal
responsibility of 12 years or younger.17 Further to this, the UN suggests that nations
“independently and objectively” ascertain the age of a child within their jurisdiction whose age is
not definitively known,17 as would be the case for trafficked children. Young people between
the age of culpability (or doli incapax if applicable) and adulthood (17–21 years depending on
jurisdiction) are responsible for their actions but do not have the full criminal liability of an
adult. Individuals in this age group are preferably subjected to rehabilitation rather than
punishment.14 Offenders who are not classed as children, but instead deemed to be legally adult,
accordingly enter the adult justice system, albeit some jurisdictions (eg, the UK) recognize the
benefits of imprisoning young adults separately from adults .25 years of age.18 This segregation
is justified in order to limit juvenile exposure to adult correctional attitudes, philosophy, and
culture, as well as to protect youths from sexual and physical violence.19,20 Incarceration can
expose vulnerable individuals to additional emotional and physical risk because some of the
coping mechanisms that are required to adjust to the prison environment include antisocial
behavior, self-injury, and depression.19 In addition, the incidence of reoffending reportedly
increases when juveniles are detailed in adult correctional facilities.20 These legal age
groupings, and the implications for the criminal justice system, put the onus on individual
jurisdictions to clearly define not only the age of majority but also the age of minority of
individuals within their respective judicial systems.

Child pornography Child pornography is generally accepted to refer to the visual assessment of
still and video images of individuals under the age of consent (“Age of consent refers to the
minimum age of a person with whom another person is legally permitted to engage in sexual
activity”.21 Age of consent varies by jurisdiction, from 12 years (eg, Chile, Mexico, Paraguay)
to 18 years (eg, Egypt, Guatemala, Haiti), albeit it is most frequently ∼16 years of age.21 The
age of consent, however, is irrelevant in the context of pornography in many jurisdictions, which
typically can only legally involve individuals who are at least 18 years of age. Some jurisdictions
(eg, Germany) make a distinction between child pornography that involves children ,14 years of
age and juvenile pornography engaging adolescents ,18.22 “Child pornography means any
representation, by whatever means, of a child engaged in real or simulated explicit sexual
activities or any representation of the sexual parts of a child for primarily sexual purposes”.23
Most jurisdictions consider the production, distribution, reception, and possession of images of
child pornography illegal.

It is clearly imperative that the identification of pornographic material involving subjects ,18
years of age is performed accurately; because the individual(s) in question may not be available
for an actual physical assessment, age assessment is usually based solely on visual inspection of
secondary sexual characteristics.24 The latter is not necessarily straightforward, with recent
research demonstrating that the visual assessment of suspected pedo-pornographic images can
result in the incorrect identification of adults as children 67% of the time.25 This was deemed to
be due to the differential timing of developmental maturity between populations. This research
lends further support to the importance of due consideration of population specificity in relation
to forensic age assessment (see “The necessity for population-specific statistical data”), albeit in
the context of child pornography, it is especially important that children are not mistakenly
identified as adults.

Age estimation in the living is one of the most important tasks of a forensic practitioner
especially in developing countries where birth records are often not well-maintained. Despite the
fact that there are a number of laws requiring registration of births (e.g Registration of Births and
Deaths Act in India) most births are not properly recorded. We get a number of cases every day
for estimation of age in living individuals in various situations, both criminal and civil. Let us
have a glimpse into a few such situations.

Civil Cases

The minimum legal age for marriage in India is 21 years for boys and 18 years for girls. When a
boy and girl want to marry in a court of law (this usually happens when they have eloped and
want to marry against the wishes of their parents), the court official demands an age certificate
from both of them. In case of non-production of this certificate, the court may refer the case to an
age clinic (as is regularly run by the Forensic Medicine department of the Maulana Azad
Medical College, New Delhi, India) for estimation of age.

Criminal cases

The legal age of consent by a girl for sexual intercourse according to Indian law is 16 years. If a
boy and a girl have eloped and have had intercourse willingly, the boy may still be prosecuted
for rape, if the girl happens to be below 16 years of age. If the girl were above 16 years, it is not
infrequent in such cases for the girl's parents to destroy her birth certificate (even if it were
there), and claim their daughter's age to be below 16 years. This is done with a view to have
revenge from the boy who instigated their daughter to run away from home. In such cases too,
the police refers the case to the doctor for estimation of age.
Ages of Medicolegal importance

Following ages are usually relevant in various medicolegal situations:

Medicolegal importance of 1 year of age

1. According to South Carolina's child passenger restraint law, children from birth to 1 year
old, or who weigh less than 20 pounds, must be secured in a rear-facing child safety seat.
(http://www.buckleupsc.com/cps/laws.htm). Washington state also has a similar law
(http://depts.washington.edu/booster/anton_skeen_bill.html). Similar laws exist in several
other nations (http://www.ideamerge.com/leasing/childseat.html)
2. In some countries, such as Canada, Italy, the United Kingdom and Australia, murder of a
child less than one year of age by its own mother is not considered homicide. Instead, the
mother is charged with a lesser offence of infanticide for which the punishment is lesser.
This is because such murders could be due to post-partum depression, or 'baby-blues'
[supposed to be due to the effects of lactation and other aspects of post-natal care].
(http://en.wikipedia.org/wiki/Murder)

Medicolegal importance of 2 years of age

1. According to the Code of Maryland, in certain cases of alimony, a determination of

potential income may not be made for a parent who is caring for a child under the age of
2 years for whom the parents are jointly and severally responsible. (For details
visit http://www.dhr.state.md.us/csea/help.htm)

Medicolegal importance of 3 years of age

1. According to the UK law, if a child under 3 years old is carried in the front seat of a car,
an appropriate child restraint MUST be used (the adult seat belt is not sufficient).
Children under 3 years old may not travel in the front unless they are in a child restraint.
If carried in the rear seat, an appropriate child restraint MUST be used, IF AVAILABLE.
If an appropriate restraint is fitted in the front of the car, but not the rear, children under 3
 years old MUST sit in the front and use that restraint. Remember, one could move the
restraint from the front to the rear if one wished. Rearward-facing seats are designed to be
used in the rear as well as the front. One should always put a rearward-facing baby seat in
the rear if is a front passenger airbag fitted.
(http://www.childcarseats.org.uk/law/index.htm)

Medicolegal importance of 4 years of age

1. Under Pennsylvania law, children under 4 years of age are required to use a child
restraint device. Nonuse is a primary offense. Children 4 to under 8 years of age are
required to use a booster seat. It is a secondary offense. The fine is a sliding fine up to
$100.00. (http://www.psp.state.pa.us/psp/cwp/view.asp?A=310&Q=165399)

Medicolegal importance of 5 years of age

1. According to Section 6 (a) of The Hindu Minority and Guardianship Act 1956, a minor
who has not completed the age of 5 years shall ordinarily be in the custody of the mother.

Medicolegal importance of 6 years of age

1. Under California law, automobile passengers under 6 years or lighter than 60 pounds
must be securely fastened in a child safety seat.
(http://webtrafficschool.com/wts/content/California/s3_1ca.html).
2. According to section 154 of Crimes Act 1961 (New Zealand), Every one is liable to
imprisonment for a term not exceeding 7 years who unlawfully abandons or exposes any
child under the age of 6 years. (http://www.legislation.govt.nz/browse_vw.asp?content-
set=pal_statutes).

Estimation of age from X-rays

Age can usually be estimated in the living from the following four criteria (1) Teeth (2)
Ossification of bones (3) Secondary sex characters (4) General development (in case of
children). In this paper we shall concentrate on the estimation of age from X-rays only.
Age from Sternum

This is usually a neglected bone even by forensic practitioners engaged in the determination of
age. But it can give strikingly accurate ages. Figure 1 is an example. This case was brought to the
author for age estimation. A lateral X-ray of chest was advised. All the four pieces of sternum
can be seen clearly.

The third and fourth piece have almost united, which allowed the author to opine on the age as
around 15 years. This was later found to be true from other evidences. Figure 2 shows the usual
ages of fusion of other parts of this bone.

Age from femur and hip bone

Figure 5. Lateral X-ray foot in a eight and a half year old male (Click to enlarge).

The case shown in figure 3 was a male, who was brought to the author for alleged sodomy on
him. The police wanted to know his age, as a tender age could lead to stricter punishment to the
accused. If we look at the X-ray carefully, we see that the head of femur has appeared. This
meant that the age was above 1 year. But the greater trochanter has not yet appeared which
allowed us to say that he was below 4 years. The actual age of the boy was found to be 2 and a
half years from other evidences.

The case shown in figure 4 is also a male. He was brought as he had stolen some jewelry from a
female, and he had applied for confinement in a Children's home. In this case, the tri-radiate
cartilage can easily be seen which allowed us to say that the person was above 13 years and
below 15 years of age. However a very faint shadow of lesser trochanter could also be seen.
Lesser trochanter appears at around the age of 14 years. Opinion given was that the child was
between 14-15 years.

Age from foot bones

The case shown in figure 5 is very interesting, and I include this case just to show that even the
neglected foot bones can sometimes be very useful in estimation of age. This is the X-ray of an
eight and a half year old child. The Secondary center in the calcaneum has appeared (>6 years),
but has not united (<14 years). By examination of just this bone, we can limit our gap to 8 years.
Of course examination of other bones was also required to pin-point the age, but this served as an
important initial step.
 REFERENCES

1. Aggrawal A and Busuttil A. Age estimation in the living. The Police Surgeon, Edinburgh
(Journal of the Association of Police Surgeons). Number 38, Jan 1991, Pp 33-36

The reader is well advised to visit the following sites for further information on estimation of age
in the living

1. David Lucy: Human age estimation from Skeletal and dental evidence (Abstract of Ph.D.
Dissertation)
2. Age reconstruction
3. Age determination from x-ray