Investigating child abuse has some unique qualities that other investigations lack. Young children may not be able to tell you what happened, and older children may be afraid to. However, physicians, especially those trained in pediatrics or forensics, may be able to tell you what the victim cannot.
Medical knowledge can provide valuable evidence that can be used to support or refute a suspect's statements. X-rays can discover fractures and may show old, healing fractures, which can indicate previous abuse. A 4-month-old with earlier, unexplained fractures, for instance, has likely been abused. No one that young should have been involved in that many accidents. A CAT scan can show old and new blood in head injuries, says Dr. Cindy Christian, a forensic pediatrician at The Children's Hospital of Philadelphia.
Some injuries found in a medical exam have qualities that indicate abuse. For instance, Christian notes an infant with internal bleeding in the head, fractured ribs and fractured limbs in the absence of a known accident points to shaken baby syndrome. The head injury and fractured limbs are likely the result of the child's head and extremities being violently shaken and flailing back and forth. Another indication of abuse, for example, is the tearing of the labial frenum, which is the small tag of skin between the upper gum and the upper lip that can be felt by placing one's tongue or finger between the two areas. This is often caused by blunt trauma to the mouth delivered with a high degree of force. In this case, there should also be other signs of trauma near the child's mouth.
Anyone investigating child abuse cases should be educated on where this type of medical advice is available and what to do with this information when the investigation begins. It's helpful to establish where forensic capabilities are available in the community before this type of help is needed.
Medical data breaks silence
Medical evidence can also speak for the child, when the child cannot. Older children can normally relate to a physician what happened and who injured him or her. But even if a child is old enough to tell what happened and who was responsible, it doesn't mean he or she will be willing to do so, especially in an abusive situation. Investigators can use medical information to support and confirm the child's account or to recreate what might have occurred. If the investigator has sound evidence from a forensic doctor who reports the injury is a clear indicator of abuse, and not an accident, disease or congenital problem, it is powerful information to confront a suspect with and to use in court.
The younger the abused child, the more important it is to seek scientific medical data, because victim statements are not available and perpetrators may not provide accurate information. Frequently forensic doctors can narrow down the time frame when the injuries occurred, and if that is known, it may point straight to the offending caregiver. For example, in an actual case where an infant received a broken femur in the care of her grandmother, the child had stayed at the grandparents' home overnight. The grandfather reportedly had left for work earlier than when medical personnel determined the injuries might have occurred. Physicians said with high confidence that the femur of a young child is not easily broken, and would produce extreme, immediate pain when fractured and cause pronounced crying above the intensity of a normal cry. After obtaining a thorough, detailed interview with the grandmother, she led investigators exactly to when the fracture occurred when she told them the infant began crying uncontrollably in her care. When investigators confronted her, she finally admitted becoming frustrated with the baby while dressing her.