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Child Abuse Pocket Atlas, Volume 4: Investigation, Documentation, and Radiology

Child Abuse Pocket Atlas, Volume 4: Investigation, Documentation, and Radiology

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Child Abuse Pocket Atlas, Volume 4: Investigation, Documentation, and Radiology

598 pagine
1 ora
Apr 15, 2016


250 pages, 505 images, 12 contributors

In the investigation of child abuse, consistent investigative protocol and clear, thorough documentation of facts and findings are essential to ensuring justice for victims, both for those who survive and for those who do not. In order to achieve the best possible results in such cases, multidisciplinary investigative teams of first responders, law enforcement, and medical practitioners should be well prepared for the process of investigation and documentation as they work in tandem toward a just end for every case of abuse.

Readers in medicine, law enforcement, and any other readers involved with child abuse and death investigations will enjoy the benefit of Child Abuse Pocket Atlas Series, Volume 4: Investigation, Documentation, and Radiology, a compact and accessible guide to investigation and documentation.
Apr 15, 2016

Informazioni sull'autore

Randell Alexander, MD, PhD is a professor of pediatrics at the University of Florida and the Morehouse School of Medicine and has served on several state child death review committees. He is an active researcher, lectures widely, and testifies frequently in major child abuse cases throughout the country.

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Child Abuse Pocket Atlas, Volume 4 - Randell Alexander, MD, PhD

Chapter 1


Craig Smith

Det Sgt Joe Bova Conti

The role of the police in child-maltreatment cases is first to determine if a crime has been committed and then to gather evidence regarding that crime. When a child is hurt, the police work most effectively with medical personnel and child protection workers in determining if the injury is deliberate, accidental, or the result of a natural disease process. Each discipline involved brings a set of skills to the investigation that can be integrated into a multidisciplinary environment. Doctors find that certain accidental injuries and diseases can be difficult to differentiate from deliberately inflicted damage. Child protection workers may be unable to discern if a caregiver is being deceptive. A police investigation often helps to overcome these difficulties.

In cases of suspected child abuse, the police investigator interviews potential suspects and witnesses, conducts scene examinations, and collects evidence for analysis. In suspected child abuse cases, a thorough police investigation is as essential as a thorough home assessment or medical examination.

Doctors, child protection workers, and police investigators have specific duties during the gathering of information from caregivers in cases of suspected child abuse. Doctors are responsible for understanding what the caregiver knows about the injury in order to prescribe appropriate treatment; child protection workers determine if the injured child or any other children are in an unsafe environment; and police investigators gather information in order to establish if a crime has been committed, and if so, collect evidence to support the filing of charges.

Abusers will often attempt to elicit specific information from medical personnel or child protection workers in order to tailor their explanation of the injuries suffered by the victim; therefore, it is essential that professionals refrain from discussing possible mechanisms of injury with caregivers who may in fact be abusers. It is the responsibility of the police, not the medical personnel or child protection workers, to confront suspected child abusers during an interrogation.

The most basic element of any child abuse investigation is the interview. Doctors, nurses, and ambulance personnel should be interviewed as soon as possible in order to get their version of the events while it is still fresh in their minds. Investigators usually interview people individually so as to avoid any cross contamination. While detailed statements require a significant amount of time, they are essential to ensure that stories do not change over time. Seemingly insignificant details are frequently used to refute or support the account of an individual. If a caregiver states that he called the hospital as soon as he found his child unconscious as a result of a fall, subsequent evidence that he called 2 other relatives before seeking medical attention will cast his story in a negative light.

In most child abuse cases, the police should initially interview all caregivers in a nonaccusatory manner and attempt to gain as much detailed information about the child’s injuries as possible (Table 1-1).


Case Study 1-1

This 2-year-old child’s death was investigated by police due to the child’s small stature and the presence of suspicious markings on his body. The child’s parents were poor housekeepers, and the one relatively clean room in the otherwise messy house caused investigators to suspect that the scene had been altered. Investigators learned that the child suffered from a congenital disease, which eventually led to his natural death. A seat belt strap caused the neck bruise while the bleeding in the ear and small stature of the child were common features of the congenital disease.

Figure 1-1-a. The room in which the child was found dead. The child was taken to the hospital by the parents, and the room was somewhat cleaned up by relatives prior to the arrival of the police.

Figure 1-1-b. A room adjacent to the room where this child died. This room has not been cleaned up and is more representative of the state of the household.

Figure 1-1-c. The 2-year-old boy at the medical examiner’s office.

Figure 1-1-d. A close up of a strange bruise on this 2-year-old child’s neck.

Figure 1-1-e. Blood in the ear of this child.

Figure 1-1-f. The dead child with his gastric tube attached.

Case Study 1-2

This 18-month-old boy was brought into the hospital with a suspicious bruise and cut to his back. The father of the child was a substance abuser with a criminal record for assault. Both he and the mother refused to give statements relating to this injury. Investigators eventually located the maternal grandmother who was more forthcoming. She stated that the child had fallen against the glass door of a cabinet at her home. The nontempered glass shattered and cut the child. An examination of the grandmother’s home revealed a cabinet with broken glass. The dimensions of the glass shards matched the size of the child’s injury.

Figure 1-2-a. Injuries to this child’s back.

Figure 1-2-b. The injuries to the child’s back with a ruler for scale, which is required for the analysis of photodocumentation.

The cause of this child’s injuries was determined to be accidental.

Case Study 1-3

This 2-year-old girl was brought into the hospital with severe scald burns. Investigators individually questioned a house full of witnesses who consistently stated that the child had been left unattended for a moment and climbed into a sink and turned on the hot water, scalding herself. A check of the hot water tank showed that it was set to a maximum temperature of 130 degrees Fahrenheit.

Figure 1-3-a. Note the total scald damage to this child’s left leg, while portions of the right upper thigh are undamaged.

Figure 1-3-b. This child’s right heel and upper right thigh are thoroughly scalded, but the right calf and lower right thigh have been spared.

Figure 1-3-c. Had this been a deliberate immersion burn, this child’s upper right thigh would have more spared skin as the lower leg flexed into a fetal position. The disparity of the burn patterns is consistent with an unintentional injury. These injuries were determined to be accidental, though a result of neglect on the part of the caregiver.

Case Study 1-4

This 10-year-old mentally handicapped girl was brought into a medical facility with a severe burn to her left knee. Police and child protection workers were notified because the injury initially appeared to have been abusive in nature. The child was able to explain that she had accidentally spilled hot chocolate on her leg. Her explanation was consistent with the findings of the attending physician.

Figure 1-4. The localized scalding pattern is consistent with her explanation. There is no sign of bruising or other injury that would have accompanied a deliberate infliction of a scald burn of this severity.

The cause of this injury was determined to be accidental and consistent with the history given by the child.

Case Study 1-5

This 12-year-old female was whipped with a belt. The child disclosed that her mother had inflicted the injury and the mother subsequently confessed to police and was charged with assault.

Figure 1-5. Pattern bruises from the belt to the left leg of this child.

Case Study 1-6

This 12-year-old girl’s mother beat her with a wooden spoon. During

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