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Age Estimation in the Living: The Practitioner's Guide

Sue Black (Editor), Anil Aggrawal (Editor), Jason Payne-James (Editor)
ISBN: 978-0-470-51967-7
318 pages
October 2010
Age Estimation in the Living: The Practitioner


This book summarizes and explains the main approaches to age estimation in the living, defining when a parameter may be of use and raising awareness of its limitations. This text ensures that practitioners recognize when an assessment is beyond their area of expertise or beyond verification depending upon the clinical data available. Each key approach to age evaluation has been allotted a single chapter, written by an international leader in the particular field. The book also includes summary chapters that relay readily accessible data for use by the practitioner, and includes important “ageing milestones.”

This book is indispensable where problems of immigration and legal standing, juvenile vs. adult criminal status, and responsibilities of law enforcement to protect vulnerable persons are key issues on a daily basis.  Medical practitioners, forensic practitioners such as pathology, odontology, anthropology and nursing, lawyers, and police would find this book incredibly useful.

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Table of Contents



Glossary of Abbreviations.

1 An Introduction to the History of Age Estimation in the Living (Andreas Schmeling and Sue Black).

1.1 Introduction.

1.2 Dental Development.

1.3 Skeletal Maturation.

1.4 Secondary Sexual Development.

1.5 Conclusion.


2 Immigration, Asylum Seekers and Undocumented Identity (Heather Law, Lorraine Mensah, Sue Bailey and Julia Nelki).

2.1 Asylum Seeker to Refugee.


3 Clinical and Legal Requirements for Age Determination in the Living (Philip Beh and Jason Payne-James).

3.1 Introduction.

3.2 Contrasts between Age Assessment in the Living and the Deceased.

3.3 Reasons for Age Estimation of Bodies and Human Remains.

3.4 Reasons for Age Estimation of Living Individuals.

3.5 Assessment Techniques.

3.6 How Age May Be Specifically Documented.

3.7 Birth Certificates.

3.8 Identity Cards.

3.9 Driving Licence.

3.10 Passports.

3.11 Age Verification Cards.

3.12 Other Documents.

3.13 Medical Issues.

3.13.1 Duties to Examinee.

3.14 Communication.

3.15 Summary and Conclusions.


4 Legal Implications of Age Determination: Consent and Other Issues (George Fernie and Jason Payne-James).

4.1 Introduction.

4.2 Principles of Practice.

4.3 Duties of the Examining Practitioner.

4.4 Criminal Issues in Age Determination in the Living.

4.5 Practical Implications.

4.6 Summary.


5 The Challenges of Psychological Assessments of Maturity (Julia Nelki, Pete Grady, Sue Bailey and Heather Law).

5.1 Introduction.

5.1.1 Current Status in the UK.

5.2 Need for Determination of Maturity.

5.3 Psychological Maturity as a Concept.

5.3.1 Child Development.

5.3.2 Middle Childhood.

5.3.3 Adolescence.

5.3.4 Ethical Framework.

5.4 Current Practice.

5.5 Suggestions for a Framework for Good Practice.

5.5.1 Setting.

5.6 Summary and Conclusion.

Appendix 5.A Proposed Framework, Based on Common Assessment Framework (Department of Schools Families and Children, 2007).


6 Principles of Physical Age Estimation (Sue Black and George Maat).

6.1 Intra-uterine Growth and Development.

6.2 Birth and Infancy.

6.3 Childhood.

6.4 Juvenile.

6.5 Adolescence.

6.6 Adult.

6.7 Senescence.

6.8 Summary.

6.9 Growth Studies.


7 Growth, Maturation and Age (Noel Cameron and Laura L. Jones).

7.1 Growth, Maturation and Age.

7.1.1 The Concept of Time.

7.1.2 Maturity Indicators.

7.1.3 Maturational Variation.

7.1.4 Uneven Maturation.

7.1.5 Sexual Dimorphism.

7.1.6 Maturity and Size.

7.2 Assessment of Maturation.

7.2.1 Skeletal Maturity.

7.2.2 Dental Maturity..

7.2.3 Secondary Sexual Development.

7.2.4 Independence of Methods.

7.3 Secular Trends.

7.4 Worldwide Variation in the Timing of Maturation.

7.4.1 Secondary Sexual Development.

7.4.2 Dental Development.

7.4.3 Skeletal Development.

7.5 Factors Associated with the Timing of Maturation.

7.5.1 Genetic Variability.

7.5.2 Demographic Factors.

7.5.3 Biological Factors.

7.5.4 Environmental Factors.

7.6 Summary.


8 Practical Imaging Techniques for Age Evaluation (Andreas Schmeling, Sven Schmidt, Ronald Schulz, Andreas Olze, Walter Reisinger and Volker Vieth).

8.1 Introduction.

8.2 Radiation Exposure in X-ray Examinations for the Purpose of Age Estimation.

8.3 Radiological Examination of the Hand.

8.4 Radiological Examination of the Teeth.

8.5 Radiological Examination of the Clavicles.

8.6 Summary and Conclusions.


9 External Soft Tissue Indicators of Age from Birth to Adulthood (Anil Aggrawal, Puneet Setia, Avneesh Gupta, and Anthony Busuttil).

9.1 Growth Patterns.

9.2 Anthropometric Parameters in Children.

9.2.1 Growth Charts.

9.2.2 Developmental Milestones.

9.3 Pubertal Changes.

9.3.1 Stages of Pubic Hair Development Derived from Tanner (1962).

9.3.2 Stages of Axillary Hair Development Derived from Tanner (1962).

9.3.3 Stages of Development of Male Genitalia Derived from Tanner (1962).

9.3.4 Stages of breast development as derived from Tanner (1962).

9.3.5 Age of Menarche.

9.4 Areas of New Research.

9.5 Conclusion.


10 Age Evaluation and Odontology in the Living (Jane Taylor and Matthew Blenkin).

10.1 Introduction.

10.2 Overview of the Development of the Dentition.

10.3 Techniques of Dental Age Estimation.

10.4 The Sub-adult Dentition.

10.4.1 Sub-adult: Physical/Anatomical.

10.4.2 Sub-adult: Radiographic.

10.4.3 Sub-adult: Destructive.

10.5 The Adult Dentition.

10.5.1 Adult: Physical.

10.5.2 Adult: Radiographic.

10.5.3 Adult: Destructive.

10.6 Summary.


11 Age Evaluation from the Skeleton (S. Lucina Hackman, Alanah Buck and S. Black).

11.1 Background.

11.2 Fetal Age.

11.3 Birth.

11.4 Juvenile/Child.

11.5 Age Estimation from the Skeleton in Living Adults.

11.6 Medial Clavicle.

11.7 Sternal Ribs and Costal Cartilages.

11.8 Pelvis.

11.9 Skull Sutural Closure.

11.10 Laryngeal Cartilages.

11.11 Other General Ageing Features.

11.12 Summary.


12 Age Evaluation after Growth Cessation (Anil Aggrawal, Puneet Setia, Avneesh Gupta and Anthony Busuttil).

12.1 Background.

12.2 Consent.

12.3 Radiology.

12.3.1 Pubic Bones.

12.3.2 Long Bones.

12.3.3 Skull Sutures.

12.3.4 Costal Cartilages.

12.3.5 Vertebrae.

12.3.6 Laryngeal Cartilages.

12.4 Odontology.

12.5 Soft Tissues of Face.

12.6 Genetics in Age Estimation.

12.7 Physiological and Biochemical Parameters for Age Estimation.

12.8 Areas of Future Research.

12.8.1 Small Long Bones.

12.8.2 Scapula.

12.8.3 Others.

12.8.4 Histology.

12.9 Conclusion.


13 The Presentation of Results and Statistics for Legal Purposes (David Lucy).

13.1 Introduction.

13.2 Evidence and Intelligence.

13.3 Statistical Methods in Age Estimation.

13.4 Classical, or Frequentist, Approaches.

13.5 Bayesian Approaches.

13.6 The Relevance to Age Estimation.

13.7 Likelihood Ratio Approaches.

13.8 Errors of Interpretation.

13.9 Concluding Comments.

Appendix 13.A Age-Related Data from Gustafson (1950).


14 Key Practical Elements for Age Estimation in the Living (Sue Black, Jason Payne-James and Anil Aggrawal).

14.1 The Four Pillars of Age Estimation.

14.1.1 Pillar 1: Social and Psychological Evaluation.

14.1.2 Pillar 2: External Estimation of Age.

14.1.3 Pillar 3: Skeletal Estimation of Age.

14.1.4 Pillar 4: Dental Estimation of Age.

14.2 Conclusion.


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“I strongly recommend this book to anyone interested in human growth and development, or any of the many factors that influence the timing of human maturation.”  (The American Journal of Human Biology, 2012)

"All in all, a very useful book. I would highly recommend this book not only to all forensic physicians, but to everyone practicing in this field. I would imagine that his book would be highly useful for lawyers, police, medical and dental practitioners, forensic scientists. I would also recommend this book to all undergraduate and postgraduate law and medical students preparing for forensic medicine examinations." (Internet Journal of Forensic Medicine and Toxicology, 1 January 2011)

"The book is of value by advising not only what can or should be done in certain situations, but by also stating what ought not to be done . . . yhis publication will, I believe be of great value to the many professionals engaged in this field world wide, and will also be an excellent reference tool." (Internet Law Book Reviews, 2011)

"Medical researchers explain some of the approaches used to estimate the age of people who for some reason or another do not know their age, or who are trying to conceal their age. They begin by setting out the nature of the problem, in chapters on immigration, asylum seekers, and undocumented identity; clinical and legal requirements for age determination in the living; and consent issues and other legal implications of age determination. Then they consider biological matters such as challenges of the psychological assessment of maturity; principles of physical age estimation; growth, maturation, and age; practical imaging techniques for age estimation; external soft tissue indicators of age from birth to adulthood; odontology in the living; the skeleton; age evaluation after growth cessation; presenting results and statistics for legal purposes; and key practical elements for age estimation in the living. (Annotation 2011 Book News Inc. Portland, OR)" (Reference and Research Book News, February 2011)

"I would recommend this book to any individual that was responsible for determining age of subjects for legal requirements. The authors have created a very organized text to aid in verifying scientific methods used in age determination. I thank the authors for going the extra mile and creating such a complete text for use in forensic investigations." (Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology, January 2011) 

"This subject area of Age Assessment in the Living needed this book; it fills a void in the field to a very high standard." (King's College London, January 2011)

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Press Release

July 14, 2010
Author Interview: Professor Sue Black

It is argued that immigration and human trafficking have raised the importance of age estimation techniques in recent years, why is this?

A significant number of people around the world do not have any legal document to prove when or indeed where they were born.  As the human population has become more mobile, so this causes a problem for countries that expect proof of such identifiers.  In some instances the movement of people is to avoid war or hardships and in some cases it is through illegal trafficking where concealment of the truth may occur.

How do you regard the standard of age estimation techniques currently used in the British legal system?   

The standards are good but they are not precise.  We ideally would all want a cookbook situation where the presence or the absence of a feature indicates a specific age – but that is unachievable and unrealistic.  As a result, we have to ensure that we place a range of age possibilities that carries a high certainty that the individual will be placed within that range.  This is quite different to assigning a specific age that will satisfy a legal definitive age.  Are healthcare practitioners typically experienced with these techniques when called as expert witnesses?   Whilst some clinical practitioners do have some expertise within this field, the willingness to provide forensic testimony may not be strong and the understanding of the importance of the limitations of the approach may not always be at the level of admissibility.

Do you support proposals to increase the age of criminality in the UK from 10 to 12?   

This is a very difficult question and, not having a legal background, I am not sure that I am qualified to answer that one.  Would the two year difference have any impact on age estimation practitioners?  Yes it would have a difference as by 12 years of age a significant number of girls in particular will have embarked on pubertal changes.  These changes cause considerable variation in the age assessment and so although it will raise different questions for the practitioner, it will not necessarily be any easier or more difficult – just different.

Your work as a Forensic Anthropologist took you to Kosovo in 1999 how was the experience of working with an international war crimes tribunal different from working within a national legal system?

This was a very different and challenging experience on so many fronts.  Firstly was the fact that you were working to international law and with international teams.  The rules of evidence gathering and the importance of the chain of evidence were not different but the scale of operations was huge.  The conditions were hard and the security was always a concern and working solidly in these conditions for 6 weeks at a time was tiring but at all times attention to detail could never waver.

Your other international projects have included work in Sierra Leone, Iraq and Thailand, how do the standards of age estimation techniques and practitioners understanding vary internationally?

There is no doubt that each country has its own views on methodologies, their application and their relevance.  However the world of forensic anthropology is pleasingly homogeneous and therefore although there is room for individuality, the standards are largely international.  It is important to always work to the highest possible standard that the situation permits.

You founded the British Association for Human Identification, how has the association brought professionals from across the discipline together?   

The aim of BAHID, post Kosovo, was to bring together practitioners from a variety of disciplines into a very informal atmosphere where discussion, debate and new research may be sparked.  It has been operational now for nearly 8 years and we have a very loyal member set.  It has proved to be an exceptionally valuable networking capability and our second textbook is underway.

The ‘CSI effect’ is credited with making not only forensic science, but science in general, ‘cool’. Do you think this has had a positive impact attracting students to forensic anthropology?

Unfortunately whilst it may have what is viewed as a positive impact it also engenders unrealistic expectations.  Many students are seduced by the popularity of this type of media and are therefore largely unprepared for a highly demanding scientific programme where there is no guarantee of work being available as a career.  The other downside is that juries now believe they are more forensically aware than they have ever been in the past and that also engenders unrealistic expectations.

What advice would you give to students about to embark on a career in forensic anthropology? 

Students must be very realistic about the likelihood of embarking on a career in this subject.  It is a fascinating subject but the majority will not end up in this field of work.  It is difficult to get into and the student needs not only to have ability, but commitment and luck.  Perseverance is unfortunately the name of the game because there is just no easy way and neither should there be because this discipline seeks to train niche expert witnesses for UK and International courts.

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