EXAMINATION FOR DETERMINATION OF AGE
In civil cases • Identification • Employment • Marriage • Majority • Management of property • Competency as witness • Testamentary capacity
In criminal cases • Rape • Criminal abortion • Infanticide • Abduction • Prostitution • Juvenile offenders • Criminal responsibility • Competency as witness
Proforma for examination PRELIMINARIES • To, Name of investigating officer Name of police station
• Reference- letter no, date • Name • Age as stated
• Sex
• Occupation – Factories act1948 Adult – who who had completed their 18 years Adolescent – 15-18 years Children -> 14yrs but<15 yrs Note child below 14yrs is not allowed to work in factory, mines or any hazardous employment
• Address• Brought by police constable ( name, no, police station) • Identified by (name of person) • Date and time of examination • Place of examination
Consent • Question (in the language the person giving consent understands): • Are you willing to be/to have your son / daughter /ward /wife physically examined by me, and to undergo radiological examination/ to have him /her radiologically r adiologically examined to estimate your /his/her age for for the purpose of --------------- -------Knowing that you have right to refuse, but that such refusal may go against you? • Answer given: Yes / No • (If age is apparently less than 12 years, then consent of the parent / guardian is mandatory)
• Signature / thumb impression of person giving consent: • Name & signature of witness to consent:
exa mined is female, name & signature of • If person being examined female attendant / Doctor present during examination. • Identification mark (at least 2 ID marks) (complete description as to shape, colour, nature, dimensions, and location with respect to 2 fixed anatomical landmarks): • 1] Mole- A black, circular, elevated, non hairy ha iry mole of size 0.3 cm in a diameter was present over the right zygomatic region of the face 4 cm above the right angle of mandible.
• 2] Tatoo mark- A green tattoo mark of of design design ―lord hanuman‖ of size 8 cm x 5 cm, 4 cm below the left elbow joint was present on the flexor aspect of upper part of left arm.
• Date of birth: • Any documentary evidence produced: Yes / No• If yes, nature: • Documentary evidences are birth certificate, living certificate, H.S.C. and S.S.C. certificate, passport, voting card, driving licence
I.
General physical examination.
II.. II
Development of of se secondary se sexual ual ch characters.
III. II I.
Deve evelop lopment ment and and er erup upttion ion of teet eeth.
IV.
Ossification of bo bones.
General Physical Examination • Height • Weight • Chest girth at nipple level • Abdominal girth at the level of navel
• General built and appearance
Mean Height and Weight in Indian Girls Age in Years
Mean height height in cm
Average ± 2 SD in cm
Mean weight in kg
Average ± 2 SD in kg
6
118
107-128
20
15-28
7
120
109-131
22
16-30
8
126
114-138
24
16-36
9
132
119-145
28
20-42
10
138
124-152
37
22-50
11
144
130-158
39
25-56
12
151
137-165
41
27-63
13
159
145-172
46
31 – 65 31 – 65
14
160
147-174
50
35-70
15
161
148-175
54
35-72
16
162
149-175
55
39-75
17
163
150-175
56
41 -80
18
163 – 164 163 – 164
151-175
57
42-80
Mean Height and Weight in Indian Boys Age in Years
Mean height height in cm
Average ± 2 SD in cm
Mean weight in kg
Average ± 2 SD in kg
6
116
106-125
21
16-26
7
121
112-132
23
18-30
8
127
116-138
26
19-35
9
132
120-143
28
21-40
10
138
125-150
31
22-46
11
146
132-161
35
23-49
12
150
135-160
40
27-60
13
157
140-173
45
30-67
14
163
146-180
51
35-75
15
169
152-185
57
40-82
16
174
160-188
62
45-88
17
176
163-189
66
49-95
18
177
164-190
69
51-97
•
econ ary sexua c aracters females Development of breast
•
Axillary hair- (Absent/Downy /Sparse/Black/Rich/Bushy /Sparse/Black/Rich/Bushy))
•
Pubic hair- (Absent/Downy /Sparse/Black/Rich/Bushy)
•
Menarche-
•
If menarche attained yes /no ,
•
Date of last menstrual period
•
Mestrual cycle- Regular/ irregular/30 days cycle/ blood PV for how many days
•
External genitalia- female female look for the prominence pro minence of the labia and mons pubis)
econ ary sexua c aracters males • Moustache- (Absent/ Downy/rough/ Sparse/dense/Black) • Beard -(Absent/Downy/rough/Sparse/ dense/Black) • • Axillary hair - (Absent/Downy /Sparse/Black/Rich/Bushy)
• Pubic hair - (Absent/Downy/Sparse/Black/Rich/Bushy) • Graying of scalp hairs starts at temporal region around 40yrs followed by hairs of beard, moustache & chest. Baldness appears around 50yrs.
• Graying of pubic hairs starts at 55 yrs. • Voice - (Deep or soft) • Adam's apple- (Prominent/not prominent) External genitalia - (In male, look for the development of
Physical Development of a Female Years
Development Stages
•
8-9
Hormones begin to release, sometimes causing moodiness and skin sensitivity.
•
9-10
Hips start rounding out.
•
10-11
Breast nipples begin to grow, Breast tissues around and under nipple begin to appear, Growth spurt may be seen, Downy hair near labia.
Physical development of a Female •
Years
(Cont'd…) Development Stages
12-13
Axially hair, hair, Genital organs growth, Menstruation age (between 9 and14 years),
Pregnancy is possible.
•
13-14
Underpants are wet with clear mucous, more with ovulation and sexual arousal.
•
14-15
Earliest normal pregnancy, Major growth spurt complete.
•
15-16
Acne, Deepening voice.
•
16-17
Full height achieved.
Tanner stage of Pubic hair • Stage 1
Prepubertal no pubic hair, fine brown villous hair (< 12 years)
Sparse not extending on to mons • Stage 2 light pigmented (12-13 years)
pubis,
• Stage 3
Darker, coarse extending on to mons pubis, pigmented, start curling and spread (13-14 years)
• Stage 4
Covering most parts but not going up to thighs (14-15 years)
Dense hair extending to the inner • Stage 5 Mature pubic hair (> 15 years)
thighs,
Tanner stage of Breast Development • Stage 1 • • •
•
Prepubertal – Prepubertal – Elevated Elevated papilla, small fat areola (not seen before 9-10 years) Stage 2 Papilla forms a palpable nodule (Breast bud) (10-11 years) Stage 3 Breast development beyond the areola, contour of breast not defined (by 13 years) Stage 4 Contour of breast well defined, more breast (by 13 years) development with elevation of the Areola double mound Stage 5 Mature breast -more breast development with loss (by 15-16 yrs) of double mound, papilla project as nipple
Physical Development of a Male Years
Development Stages
•
8-9
Hormones begins to release, sometimes causing moodiness and skin sensitivity.
•
10-11
Testes become larger, Scrotal skin redder in colour and coarse in
texture. •
11-12
Prostate gland begins to function, Penis begins to lengthen.
•
12-13
Pubic hair growth, Growth spurt may begin, Spontaneous erections.
Physical Development of a Male Years
(Cont'd…) Development Stages
•
13-14
Rapid growth of penis, Scrotal skin colour deepens, Pseudo breast.
•
14-15
Axillary hair, Voice changes.
•
15-16
Average age when sperm matures, Can cause pregnancy, Majority of growth spurt complete.
•
16-17
Chest and shoulder will fill out, Acne, Acne, Body hair.
•
21
Full height achieved.
• Dental status • Any other finding- skin, eyes, other • Advised x-ray – x-ray –
• X-ray plate no. • Date
(III) Development & Eruption of Teeth
Reasonable reliable idea of the age can be made by examining the teeth.
Dental Examination • The tooth eruption in oral cavity occurs when the root is almost half formed. As the root becomes longer, the crown erupts through the bone and is seen outside of the jaw in an oral cavity. • Degree of formation of root and crown structures, the stage of eruption and the intermixture of temporary and permanent teeth are helpful in estimating age from birth to 25 years.
Dental Examination (Cont'd….) • The x-ray of the jaw would show developmental status of unerupted teeth and the degree of root completion in erupted teeth. • Crown and root development of the second molar, and third molar- helpful for 8 - 21 years.
Temporary Teeth 10 temporary teeth in each jaw — 4 incisors, 2 canines & 4molars
(no premolars, no 3rd molar).
Temporary Teeth Teeth
Time of eruption
Root calcification completes
Central incisor (Lower)
6 months (6 to 8m)
1/ 2 Year
Central incisor (Upper)
7 months (7 to 9m)
1/ 2 Year
Lateral incisor (Upper)
9 months (9 to 10m)
1/ 2 Year
Lateral incisor (Lower)
10 months (10 to 12m)
1/ 2 Year
1st Temp. Molar
]2 months (12 to 14m)
2 to21/2 Year
Canines
18 months (17 to 18m)
21 /2 to 3Year
2nd Temp. Molars
24 months (20 to 30m)
3 Years
Permanent Teeth 16 permanent teeth in each jaw — 4 incisors, 2 canines, 4 premolars &
6 molars.
Eruption of permanent teeth Root calcification completes
Teeth
Time of eruption
1st molar
6-7 years
9-10 years
Central incisor
6-8 years
10 years
Lateral incisor
7-9 years
11 years
1st bicuspid
9-11 years
12-13 years
2nd bicuspid
10-12 years
12-14 years
Canine
11-12 years
12-13 years
2nd molar
12-14 years
14-16 years
3rd molar
17-25 years
22-25 years
Age and number of teeth Tooth
Eruptional Eruption al
Permanent Permane nt (no of
Temporary (no of
teeth at different
teeth at different
age)
age)
1. First molar
6yrs
4
20
2. Central incisor
7 yrs
8
16
3. Literal premolar
8 yrs
12
12
4. First premolar
9 yrs
16
8
5. Second premolar
10 yrs
20
4
6. Canine
11 yrs
24
0
7 Second molar
12-14 yrs
28
0
8 Third molar
17-25 yrs
32
0
Space for third molar In the back of jaw-
• In females- 15-16 years. • In males- after 16 years of age.
Radiological Assessment of Teeth Development
• Made by viewing X-ray films. • Orthopantogram- provided the facility is available. • Otherwise, X-ray of the oral cavity- Oblique tangential view with the mouth open . • A tooth erupts in an oral cavity only when there is a half root formation inside the jaw. • Teeth develop earlier in females in comparison to males. • The germination centre of the third molar appears between 7 and 9 years.
Crown and Root Development of the Third Molar
Crown Formation Age (On X-ray) 15 years • Complete Crown Formation • Crown with 1/3rd Root Formation 16 Years • Crown with 2/3rd Root Formation 17 Years • Crown with Complete Root Formation 18 years 21 years • Apical Closure of Root (Calcification of the root completed) The eruption and development of teeth in females takes place 1 year earlier than males.
Some helpful notes on Calcification of teeth • When molars erupt, the root is about 1/3 of its final length. Or in other words, when roots achieve 1/3 of their final length, the molars erupt. • At the time of eruption the apical closure has not occurred
Orthopantogram Orthopantog ram (OPG)
Age from OPGs • OPG of a child between 8-9 years. • Both incisors do not have any tooth germ underneath them, indicating they are permanent. Age >8 years. • Premolar shows a tooth germ beneath it. The germ is of the permanent tooth. This means the premolar is actually a temporary molar. Since permanent premolar has not appeared. Age <9 years .
Charting of teeth• Universal system- Teeth are numbered 1to 16 from right to left and 17 to 32 from lower left to lower right 1
2
3
4
5
6
7
32 31 30 29 28 27 26
8
9
10
11 12 13 14 15 16
25 24 23
22 21 20 19 18 17
•Palmer notation Right
Left
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
Charting of teeth
• Haderup system• It is similar to Palmer notation except that it uses a (+) sign for upper teeth and (-) lower lo wer teeth +8 +7 +6 +5 +4 +3 +2 +1 +1 +2 +3 +4 +5 +6 +7 +8
-8
-7
-6
-5
-4
-3
-2
-1
-1
-2
-3
-4
-5
-6
-7
-8
Charting of teeth
• FDI (Federation Dentaire Inetrnationale)Inetrnationale)• FDI system substitutes for permanent teeth 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27
28
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37
38
• For temporary teeth 5,6,7and 8 numbers are used
2nd temporary molar appeared
Mixed dentition -first molar appeared
2nd Permanent molar appeared
Provisional age certificate On clinical examination of individual ,age is ---- years. however , the final opinion regarding the age should be collected from this office after submission of radiological report . Date and place doctor
sign. name and designation of
(IV) Ossification of bones The first step in ossification ossif ication of the cartilage is that the cartilage cells, at the point where ossification is commencing and which is termed a ossification center. It enlarge and arrange themselves in rows. There are two types of ossification centers - primary and secondary. secondary.
X-Ray Findings in Bones •
In long bones, the appearance and fusion of epiphyses can be evaluated for the purpose of age estimation. The findings can be described as: “no fusion” “fusing” “recently fused: “fused”.
•
X-ray of the hands, wrists, elbows, shoulders, feet, ankles, knees, the pelvis, and hip joints are very useful.
•
The fusion of bones takes place 1 year earlier in females than in males.
X-ray Shoulder joint (AP view) Age • 1 year • 3 years • 5 years
(for the age group 17-18 years) Appearance head of humerus greater tuberosity lesser tuberosity
All these centers unite at 6 years and form conjoint epiphysis.
• 11 years • 15 years
tip of coracoid unites at 16 yrs tip of acromion appears, unites
• 19 years
with scapula at 18 years.
secondary center for sternal end of clavicle appears unites
with shaft by 21 years.
X-ray Shoulder (example) • Head and greater tuberosity are appeared but not fused : age <18 years.
X-ray Elbow Joint (AP view) (for the age group 5-16 years) Age
Appearance Capitulum
•
1year
• • • •
5-7years Medial epicondyle 10 years Trochlea 11 years Lateral epicondyle 14 years of age the 3 centers i.e. Capitulum, Trochlea and Lateral Lateral epicondyle epicondyle unite together and form a conjoint epiphysis. This conjoint epiphysis unites with the shaft of humerus.
•
16 years of age The last centre to unite at elbow is medial epicondyle, which unites with humerus shaft.
•
5 years
Head of radius (upper end), It unites at 16 years.
•
9 years
Upper end of ulna, It also unites at 16 years.
X-ray elbow (example) • In the current xray, all four centres (medial epicondyle, capitulum, trochlea and lateral epicondyle) can be
seen separately, indicating the age is around 11yeras14years.
Wrist Joint and hand (X-ray AP view) (for the age group 16-17 yrs) • •
Age Appearance 2 years Lower end of radius 6 years Lower end of ulna Both unite with shafts around 19 years.
• • • • • • •
Carpal bones appearance and ossification 2 months Capitate 3 months Hamate 3 years Triquetral 4 years Trapezium, Scaphoid, Lunate 4-5 years Trapezoid 9-11 years Pisiform Metacarpals Head of the first metacarpal unites at 16 years while the heads of other metacarpals unite at 17 years (Thumb first).
X-ray Wrist (example) • Appearance of carpal bones – bones – (lateral to medial, distal to proximal)
yr yr mth mth 4 5
2 3
• T T C H • S L T P 4 4
3 9-12
yr yr yr
yr
• Age 9-16 yrs.
Sternum • Sternum body has 4 centers since birth, which unite from below -> upwards direction. 3rd and 4th parts unite at 15 years. 2nd and 3rd unite at 20 years. 1st and 2nd parts unite at 25 years.
• Manubrium unites with body of sternum at 60 years. • Tip of Xyphoid process appears at 3 years and unites at 40 years with body of sternum.
X-ray Sternum (example 1) • Lateral view of sternum is taken. • Middle four pieces of sternum unite from below upwards, between 15-25 years of age and xiphoid procees fuses with at 40 years manubrium fuses with body at 60 years • In this case, the upper two pieces have not united. • Age – 15-20 yrs.
X-ray Sternum (example 2) • Showing sternum and its pieces in a 16 year old male. • The third and fourth piece have almost united. • Age- around 15 years.
Upper limbs: summary In the long bones of the upper limb, the first
to join is the elbow joint followed by the shoulder and wrist joints. The carpal bones are useful for age in the
1/2 to 12 year age group.
Hip Joint (X – ray ray AP view) Age • 6.5 – 8 year
• 14 years
Appearance Ischio-pubic ramus unites by 61/2 years Iliac crest ossification centre appears, unites by 20 years.
• 14 years • 16 years
Tip of pubis centre appear Tip of ischium appear
Both these centers unite by 20 years.
• 13 years • 15 years
Acetabulam cap appears as triradiate cartilage Triradiate gets united and appears as a cup
X-ray Hip joint (example) • Iliac crest not appeared: <14 yr • Triradiate cartilage still visible: <15 years
• Greater trochanter not united: <17 years
X-ray Pelvis & femur (AP view) • Pelvis is and femur in a 2 1/2 year old male child. • Head of femur has appearedage > 1 year. • Greater trochanter has not yet appeared- age < 4 years.
X-ray Rt. Hip joint (AP view)
• The tri-radiate cartilage can easily be seen- age > 13 years and < 15 years of age. • However, a very faint shadow of lesser trochanter can also be seen. Lesser trochanter appears at around 14 years. • Opinion given was that the child was between 14-15 years.
X-ray Knee jt. (example)
• Lower end of femur, upper end of tibia & fibula not united: <18 years
X-ray Ankle jt. (example) • Lower end of tibia and fibula not united. • Age <16 years.
X-ray foot (example) • This is the X-ray of an 8½ year old child. • The Secondary center in the calcaneum has appeared (>6 years), but has not united (<14 years).
Lower limbs: summary In the long bones of the lower limb, the first
to join is the knee joint followed by the hip and ankle joints. The hip-bones are useful for age in the 13 to
22 age group.
Summary of X-Ray Advised Age Group
• 14-16 years
• 16-18 years
• 18-22 years
X-Ray Advised
Shoulder, Elbow, Wrist, Dentition, Pelvis including the upper end of femur and iliac crest. Wrist, Elbow, Shoulder, Pelvis, Dentition for the 2nd and 3rd molar. Pelvis, shoulder, medial end of clavicle, third molar, wrist, sternum.
Estimation of age as a whole • 2-6 years- tarsal and carpal bones, appearance of epiphyses of long bones. • 6-13 years- permanent teeth, epiphyseal centers.
• 13-16 years- Changes at puberty, elbow joint. • 16-22 years- epiphyses of the most of the long bones with shafts, viz., union at elbow and wrist, followed by head of hummers. • It is essential the x-rays of wrist, elbow, shoulder, pelvis joints and jaw are taken for determining the age of the trafficked victim.
Opinion Expression by Medical Officer
OPINION OF AGE
• Provisional age certificate immediately • Send for X-rays with id marks on requisition form • Final report after radiologists opinion(34hrs) • Range should be 6months to 1year and not more upto 25 years
GIVE OPINION AT THE VERY EARLIEST JUSTICE DELAYED IS JUSTICE DENIED
