Palaeopathology of Children: Identification of Pathological Conditions in the Human Skeletal Remains of Non-Adults provides archaeological examples of pathological child remains with varying degrees of disease manifestation, and where possible, presents illustrations of individually affected bones to help with identification. The structure and inclusion of photographs and summary diagnostic tables make this suitable for use as a textbook. Each chapter includes a table of international archaeological cases collated by the author from published and unpublished literature.
Child skeletal remains come in a variety of different sizes, with bones appearing and fusing at different times during growth. Identifying pathology in such unfamiliar bones can be a challenge, and we often rely on photographs of clinical radiographs or intact anatomical specimens to try and interpret the lesions we see in archaeological material. These are usually the most extreme examples of the disease, and do not account for the wide degree of variation we may see in skeletal remains.
Provides a comprehensive review of the types of pathological conditions identified in non-adult skeletal remains
Contains chapters that tackle a particular disease classification
Features for each condition are described and illustrated to aid in the identification
This chapter introduced the importance of the study of child paleopathology to our understanding of health in the past. The development of child studies is discussed, along with a brief outline of growth and development, bone modeling and remodeling, and the evolving immune system. Issues regarding hidden heterogeneity, frailty, diseases selectivity, lesion expression, and differential diagnoses are explored in regard to the study of a childâs skeletal remains.
Keywords
Differential diagnosis; Frailty; History; Immunity; Pediatric bone
Introduction
A child's skeleton carries a wealth of information about their physical and social life; from their birth, growth and development, diet and age at death, to the social and economic factors that exposed them to trauma and disease at different stages of their brief lives. Cultural attitudes dictated where and how infants and children were buried, when they assumed their gender identity, if they were sacrificed or exposed to physical abuse, and at what age they were set to work or considered adults. As vulnerable members of a society who are wholly dependent on the care of others, understanding the survival of infants has the potential to provide an accurate measure of a populationâs ability to adapt to their particular environmental circumstances (Mensforth et al., 1978). Children have emerged as important social actors in the past, contributing to material culture and influencing the archeological record (Baxter, 2006, 2008), and we are increasingly aware of their importance to our understanding of past society, culture, and the life lived (Halcrow and Tayles, 2011). A child's genetic inheritance may determine their level of frailty and susceptibility to disease and death, but their health is profoundly influenced by overlapping and interconnected socioeconomic layers, comprising their family, immediate social environment, and cultural norms that dictate their lives (World Health Organisation, 1993) (Fig. 1.1). As children age and begin to interact with their peers and their wider surroundings they are exposed to new physical hazards and pathogens (Halcrow and Tayles, 2011; Kamp, 2006), and these risks increase as they enter adolescence (Lewis et al., 2015). Hence, our understanding of disease and trauma in a child in the past must also be informed by their physical age and transforming social identity that influenced their freedoms and experience of risk.
Despite the rising popularity of nonadult paleopathology, there are still challenges. Many pertain to the nature of growing bone. For example, rickets appears readily as large quantities of structurally inferior new bone are rapidly deposited at the growth plate, while in mature bone a slower rate of turnover means lesions take much longer to appear and are more subtle (Brickley et al., 2005). Conversely, accelerated growth then allows the inferior bone to be quickly replaced by normal tissue as the minerals needed for normal bone formation are once again received, causing both the macroscopic and radiographic signs of the disease to disappear from the skeleton within months (Harris, 1933). The highly plastic nature of childrenâs bones means that they are less prone to complete fracture, but instead suffer partial breaks (greenstick fractures), buckling or bowing deformities that are hard to identify in dry bone (Lewis, 2000, 2007, 2014). We are still unable to effectively distinguish between new bone formation as the result of infection or trauma, from that which forms as part of the normal growth process in young children, often hindering our ability to explore such pathology in children younger than 4years of age. In ad...