Print this page Share

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.

See More

Table of Contents

Foreword xiii

Preface xv

Glossary of Abbreviations xvii

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

1.1 Introduction 1

1.2 Dental Development 3

1.3 Skeletal Maturation 5

1.4 Secondary Sexual Development 8

1.5 Conclusion 10

References 12

2 Immigration, Asylum Seekers and Undocumented Identity 19
Heather Law, Lorraine Mensah, Sue Bailey and Julia Nelki

2.1 Asylum Seeker to Refugee 26

References 28

3 Clinical and Legal Requirements for Age Determination in the Living 30
Philip Beh and Jason Payne-James

3.1 Introduction 30

3.2 Contrasts between Age Assessment in the Living and the Deceased 31

3.3 Reasons for Age Estimation of Bodies and Human Remains 32

3.4 Reasons for Age Estimation of Living Individuals 32

3.5 Assessment Techniques 37

3.6 How Age May Be Specifically Documented 37

3.7 Birth Certificates 38

3.8 Identity Cards 38

3.9 Driving Licence 38

3.10 Passports 39

3.11 Age Verification Cards 40

3.12 Other Documents 40

3.13 Medical Issues 40

3.13.1 Duties to Examinee 40

3.14 Communication 41

3.15 Summary and Conclusions 41

References 42

4 Legal Implications of Age Determination: Consent and Other Issues 43
George Fernie and Jason Payne-James

4.1 Introduction 43

4.2 Principles of Practice 44

4.3 Duties of the Examining Practitioner 47

4.4 Criminal Issues in Age Determination in the Living 48

4.5 Practical Implications 51

4.6 Summary 53

References 54

5 The Challenges of Psychological Assessments of Maturity 55
Julia Nelki, Pete Grady, Sue Bailey and Heather Law

5.1 Introduction 55

5.1.1 Current Status in the UK 57

5.2 Need for Determination of Maturity 58

5.3 Psychological Maturity as a Concept 59

5.3.1 Child Development 60

5.3.2 Middle Childhood 61

5.3.3 Adolescence 62

5.3.4 Ethical Framework 63

5.4 Current Practice 65

5.5 Suggestions for a Framework for Good Practice 67

5.5.1 Setting 68

5.6 Summary and Conclusion 69

Appendix 5.A Proposed Framework, Based on Common Assessment Framework (Department of Schools Families and Children, 2007) 69

References 74

6 Principles of Physical Age Estimation 77
Sue Black and George Maat

6.1 Intra-uterine Growth and Development 79

6.2 Birth and Infancy 82

6.3 Childhood 83

6.4 Juvenile 85

6.5 Adolescence 85

6.6 Adult 86

6.7 Senescence 87

6.8 Summary 88

6.9 Growth Studies 89

References 91

7 Growth, Maturation and Age 95
Noël Cameron and Laura L. Jones

7.1 Growth, Maturation and Age 95

7.1.1 The Concept of Time 95

7.1.2 Maturity Indicators 98

7.1.3 Maturational Variation 99

7.1.4 Uneven Maturation 99

7.1.5 Sexual Dimorphism 100

7.1.6 Maturity and Size 100

7.2 Assessment of Maturation 101

7.2.1 Skeletal Maturity 101

7.2.2 Dental Maturity 101

7.2.3 Secondary Sexual Development 102

7.2.4 Independence of Methods 102

7.3 Secular Trends 102

7.4 Worldwide Variation in the Timing of Maturation 104

7.4.1 Secondary Sexual Development 104

7.4.2 Dental Development 109

7.4.3 Skeletal Development 109

7.5 Factors Associated with the Timing of Maturation 112

7.5.1 Genetic Variability 112

7.5.2 Demographic Factors 113

7.5.3 Biological Factors 114

7.5.4 Environmental Factors 116

7.6 Summary 120

References 120

8 Practical Imaging Techniques for Age Evaluation 130
Andreas Schmeling, Sven Schmidt, Ronald Schulz, Andreas Olze, Walter Reisinger and Volker Vieth

8.1 Introduction 130

8.2 Radiation Exposure in X-ray Examinations for the Purpose of Age Estimation 131

8.3 Radiological Examination of the Hand 133

8.4 Radiological Examination of the Teeth 138

8.5 Radiological Examination of the Clavicles 142

8.6 Summary and Conclusions 144

References 145

9 External Soft Tissue Indicators of Age from Birth to Adulthood 150
Anil Aggrawal, Puneet Setia, Avneesh Gupta, and Anthony Busuttil

9.1 Growth Patterns 151

9.2 Anthropometric Parameters in Children 151

9.2.1 Growth Charts 152

9.2.2 Developmental Milestones 159 Head Control 159 Rolling 159 Sitting 160 Gross Motor 160 Fine Motor 161 Social and cognitive 161 Speech and language 162

9.3 Pubertal Changes 162

9.3.1 Stages of Pubic Hair Development Derived from Tanner (1962) 163 Pubic Hair Development in Males 164 Pubic Hair Development in Females 164

9.3.2 Stages of Axillary Hair Development Derived from Tanner (1962) 164

9.3.3 Stages of Development of Male Genitalia Derived from Tanner (1962) 166 Testicular Volume 166 Age of First Erection and Ejaculation 167

9.3.4 Stages of breast development as derived from Tanner (1962) 168

9.3.5 Age of Menarche 168

9.4 Areas of New Research 170

9.5 Conclusion 170

References 171

10 Age Evaluation and Odontology in the Living 176
Jane Taylor and Matthew Blenkin

10.1 Introduction 176

10.2 Overview of the Development of the Dentition 177

10.3 Techniques of Dental Age Estimation 179

10.4 The Sub-adult Dentition 180

10.4.1 Sub-adult: Physical/Anatomical 180 Tooth Counts 180

10.4.2 Sub-adult: Radiographic 182 Atlas Style Techniques 182 Techniques Employing Measurement 184

10.4.3 Sub-adult: Destructive 187 Histological Techniques 187 Aspartic Acid Racemization 187

10.5 The Adult Dentition 187

10.5.1 Adult: Physical 188 Tooth Wear 188

10.5.2 Adult: Radiographic 188 Third Molars 189 Secondary Dentine Apposition 190

10.5.3 Adult: Destructive 191 The Gustafson Method 191 Root Transparency 191 Amino Acid Racemization and Histological Techniques 191

10.6 Summary 191

References 193

11 Age Evaluation from the Skeleton 202
S. Lucina Hackman, Alanah Buck and S. Black

11.1 Background 202

11.2 Fetal Age 204

11.3 Birth 208

11.4 Juvenile/Child 210

11.5 Age Estimation from the Skeleton in Living Adults 221

11.6 Medial Clavicle 222

11.7 Sternal Ribs and Costal Cartilages 223

11.8 Pelvis 224

11.9 Skull Sutural Closure 224

11.10 Laryngeal Cartilages 225

11.11 Other General Ageing Features 226

11.12 Summary 226

References 226

12 Age Evaluation after Growth Cessation 236
Anil Aggrawal, Puneet Setia, Avneesh Gupta and Anthony Busuttil

12.1 Background 236

12.2 Consent 237

12.3 Radiology 237

12.3.1 Pubic Bones 239

12.3.2 Long Bones 242

12.3.3 Skull Sutures 243

12.3.4 Costal Cartilages 246 Sternum 246

12.3.5 Vertebrae 247

12.3.6 Laryngeal Cartilages 250

12.4 Odontology 250

12.5 Soft Tissues of Face 251

12.6 Genetics in Age Estimation 252

12.7 Physiological and Biochemical Parameters for Age Estimation 253

12.8 Areas of Future Research 254

12.8.1 Small Long Bones 254

12.8.2 Scapula 254

12.8.3 Others 254

12.8.4 Histology 256

12.9 Conclusion 257

References 257

13 The Presentation of Results and Statistics for Legal Purposes 267
David Lucy

13.1 Introduction 267

13.2 Evidence and Intelligence 269

13.3 Statistical Methods in Age Estimation 270

13.4 Classical, or Frequentist, Approaches 271

13.5 Bayesian Approaches 271

13.6 The Relevance to Age Estimation 272

13.7 Likelihood Ratio Approaches 274

13.8 Errors of Interpretation 279

13.9 Concluding Comments 280

Appendix 13.A Age-Related Data from Gustafson (1950) 281

References 282

14 Key Practical Elements for Age Estimation in the Living 284
Sue Black, Jason Payne-James and Anil Aggrawal

14.1 The Four Pillars of Age Estimation 286

14.1.1 Pillar 1: Social and Psychological Evaluation 286

14.1.2 Pillar 2: External Estimation of Age 286

14.1.3 Pillar 3: Skeletal Estimation of Age 288

14.1.4 Pillar 4: Dental Estimation of Age 289

14.2 Conclusion 290

Index 291

See More


“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)

See More

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.

See More

Related Titles

Back to Top