Synopses of the Portable Guides

Recognizing When a Child's Injury or Illness Is Caused by Abuse

Robert Hugh Farley, M.S., Detective, Cook County Sheriff's Police Department, Federal Child Exploitation Strike Force, Chicago, Illinois, and Robert M. Reece, M.D., Clinical Professor of Pediatrics, Tufts University School of Medicine, Medford, Massachusetts, and Director, Institute for Professional Education, Massachusetts Society for the Prevention of Cruelty to Children (MSPCC), Boston, Massachusetts.

In cases involving a bruised or otherwise injured child, or one with a suspicious illness, law enforcement and child protective services personnel are faced with the question "Could this be child abuse?" To answer this question accurately, they must be able to evaluate the credibility of explanations given by parents or caretakers, and to do that, they must be able to recognize discrepancies between an injury and its reported cause. This guide provides criteria to help investigators make these determinations. The topics covered include repetitive accidents, bruises, burns, poisoning, head injuries, eye injuries, and internal injuries. The discussion of bruises addresses how to judge the age of a bruise, what the configuration of a bruise indicates about its origin, and what the causes of natural or normal bruising are. The section on burns discusses characteristics of the history, location, and pattern of burn injuries that suggest whether the burn was accidental or not. An "Investigator's Checklist for Use in Suspected Cases of Physical Child Abuse" sums up important questions and issues for investigators to consider.

This guide also includes a section devoted to sudden infant death syndrome (SIDS), including a comprehensive table of "Criteria for Distinguishing SIDS From Fatal Child Abuse and Other Medical Conditions." The following criteria are addressed: the circumstances surrounding the death of the child; the age of the child; the findings of the physical examination and laboratory studies at the time of death; the history of the pregnancy, delivery, and infancy; the findings of the death scene investigation; previous infant deaths in the family; autopsy findings; and the previous involvement of child protective services or law enforcement. The "Resources" section of this guide includes a list of publications on SIDS and contact information for seven organizations that provide information on SIDS. (NCJ 160938)

Photodocumentation in the Investigation of Child Abuse

Lawrence R. Ricci, M.D., Director of the Child Abuse Program at the Spurwink Clinic, Portland, Maine, and Brian S. Smistek, Director of Medical Media, The Children's Hospital of Buffalo, Buffalo, New York.

Photographs that clearly document a child's injuries can be critical to the prosecution of child abuse cases. Improper camera equipment and film, insufficient methods of photographing the victim's injuries, and misinformation about or mislabeling of photographs can limit the effectiveness of photographic evidence. This guide offers information on photographic equipment and methods that will aid investigators in obtaining the best possible photographic evidence in child abuse cases. The topics covered include the advantages and disadvantages of different types of cameras, methods of handling and storing film, ultraviolet photography, general procedures, and the best ways to photograph child victims. Specific methods are presented for photographing punctures, slashes, rope burns, pressure injuries, bite marks, bruises, burns, facial injuries, amputation, and signs of neglect. Guidelines are given for interacting with children who have suffered sexual abuse and for photographing their injuries. (NCJ 160939)

Sexually Transmitted Diseases and Child Sexual Abuse

Margaret R. Hammerschlag, M.D., Professor of Pediatrics and Medicine, State University of New York Health Science Center at Brooklyn, Brooklyn, New York.

Although the presence of a sexually transmitted disease (STD) in a child raises suspicions of sexual abuse, infants can acquire some STD infections from their mothers while in the womb or during delivery. Such infections may last for up to 3 years. When investigating a case involving a child with an STD, law enforcement officials must try to determine whether the infection was caused by sexual contact and, for purposes of prosecution, whether the diagnostic method was appropriate. This guide contains information that will help in both of these endeavors, including a detailed table presenting the incubation period, clinical manifestations, modes of transmission, and proper methods of diagnosis for all principal STD's. (NCJ 160940)

Diagnostic Imaging of Child Abuse

Randell Alexander, M.D., Ph.D., Associate Professor of Pediatrics, The University of Iowa, Iowa City, Iowa, and Paul K. Kleinman, M.D., Professor of Radiology and Pediatrics, Director of Pediatric Radiology, and Director of the Imaging Center for Child Abuse and Neglect, University of Massachusetts Medical Center, North Worcester, Massachusetts.

The findings of radiological imaging studies can be crucial in documenting the occurrence of physical child abuse. In some cases, an imaging study performed to diagnose another condition may provide the first indication that the child has been abused. This guide summarizes for investigators the advantages and disadvantages of x-ray studies, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and other radiological methods used in diagnosing skeletal, intracranial, and thoracoabdominal injuries. The issues addressed include when imaging studies should be performed, what modalities are best for imaging certain kinds of injuries, and what kinds of findings may indicate child abuse. Medical terminology is explained in lay terms.

This guide also discusses shaken baby syndrome at length. The authors explain how injury occurs in shaken baby syndrome, describe the symptoms found in an infant who has been violently shaken, and give recommendations for diagnostic imaging in suspected cases. This section concludes with a summary of guidelines for investigators. (NCJ 161235)

Battered Child Syndrome: Investigating Physical Abuse and Homicide

Rob Parrish, J.D., Senior Child Abuse Counsel, Children's Justice Division, Office of the Attorney General, Salt Lake City, Utah.

This guide alerts investigators to the importance of recognizing the signs of repeated beating and mistreatment that constitute battered child syndrome.

Evidence of past abuse may help refute claims that the current injuries were accidental and may prove critical to successful prosecution. Guidelines are given for interviewing parents or caretakers and medical personnel and for investigating the crime scene. The author stresses the importance of obtaining both physical evidence and a photographic record of the crime scene and the child's injuries. This guide includes some discussion of differentiating between accidental and nonaccidental injuries.

The author also focuses on child homicide and examines three conditions that must be considered when a child has died under suspicious circumstances in which there is no obvious sign of physical abuse: shaken baby syndrome Munchausen syndrome by proxy, and sudden infant death syndrome. The "Resources" section of this guide includes references on child fatalities and child fatality laws, sudden infant death syndrome, death certification, and death statistics. (NCJ 161406)

Interviewing Child Witnesses and Victims of Sexual Abuse

Karen J. Saywitz, Ph.D., Associate Professor, University of California-Los Angeles School of Medicine, and Director, Child and Adolescent Psychology Training and Services, Department of Psychiatry, Harbor&150;UCLA Medical Center, Torrance, California, and Kathleen Coulborn Faller, Ph.D., Professor of Social Work and Faculty Director of the Civitas Child and Family Program, University of Michigan, Ann Arbor, Michigan.

This guide is divided into two sections. The first, "General Guidelines for Interviewing Children," by Karen Saywitz, identifies four key attributes for conducting an interview with a child that will yield useful, factual information: flexibility, empathy, objectivity, and sensitivity to the child's level of development. Guidance on how to talk to children is given through many examples of how to phrase statements and questions in a neutral, nonjudgmental manner that is appropriate to different ages and levels of understanding. Strategies for simplifying language and for assessing a child's understanding are summarized in charts, and the author suggests ways to help children overcome their anxieties and deal with questions they don't understand. The section concludes with a detailed discussion of five phases of conducting an interview: preparation, setting and context, rapport building and developmental observations, information exchange, and closure.

The second section of this guide, "Interviewing Children Who May Have Been Sexually Abused," by Kathleen Faller, focuses on techniques for interviewing children in cases where sexual abuse has been alleged. Beginning with the challenges facing the interviewer in such cases, the discussion covers evaluating the level of likelihood that abuse has occurred, preparing for the interview, questioning, using anatomical dolls and other media, weighing the evidence, assessing the level of certainty, and deciding how to proceed. The author stresses the importance of using questions that are more open ended and avoiding leading or coercive questions. She presents a continuum of examples of investigative questions, beginning with the kinds of open-ended questions that elicit the most credible responses and concluding with the kinds of close-ended questions that should never be used with child victims. The use of polygraph tests and the significance of null findings are also addressed. (NCJ 161623)

Child Neglect and Munchausen Syndrome by Proxy

Donna Rosenberg, M.D., Assistant Professor of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, and Forensic Pediatrician, Colorado Child Fatality Review Team.

In cases of child neglect, the success of the investigation, the collection of evidence, and the court proceedings may hinge on the investigator's understanding of what constitutes neglect. This guide explores the complex issue of child neglect, beginning with the standard against which neglect is measured: the duty of the child's parents or designated caretakers to provide a reasonable and prudent level of care for the child. The primary ways in which parents may fail in this duty to a degree that constitutes neglect are then examined. These topics include the failure to provide food, fluids, medical care, nurturance, or supervision, or to intervene when the child is endangered. Under each of these areas, the circumstances that qualify as neglect are defined and the ways to detect neglect are described. These include the types of evidence to look for, the kinds of records to check, the points to look for in medical or autopsy records, and the people who should be consulted. Guidance is given on factors to consider when deciding to seek civil or criminal court involvement. The importance of distinguishing neglect caused by poverty from neglect not caused by poverty is also discussed.

This guide also addresses Munchausen syndrome by proxy (MSBP), a form of child abuse in which a parent intentionally fabricates an unidentifiable illness in the child, sometimes with serious or even fatal consequences. The author presents criteria for diagnosing MSBP and summarizes in a table the most common symptoms exhibited by children who are victims of MSBP and the mechanisms perpetrators use to cause these symptoms. Investigation by a multidisciplinary team is recommended, and the personnel needed for the team and the goals of the investigation are outlined. (NCJ 161841)

Burn Injuries in Child Abuse

Phylip J. Peltier, Criminal Investigator, San Diego District Attorney's Office, San Diego, California; Gary Purdue, M.D., Professor, Department of Surgery, The University of Texas Southwestern Medical Center, and Co-Medical Director, Burn Intensive Care Unit, Parkland Memorial Hospital, Dallas, Texas; and Jack R. Shepherd, Inspector and Executive Assistant, Investigative Services Bureau, Michigan State Police, East Lansing, Michigan.

This guide focuses on methods for determining whether a child's burn injury was deliberately inflicted or resulted from an accident. Three types of burn injuries are considered: those caused by spills or splashes, those caused by immersion in a tub or other container of hot liquid, and those caused by contact with flames or hot solid objects. Burn patterns indicative of each type of injury are described and the ways each type of burn is typically inflicted are discussed. Skin conditions that may give the appearance of a burn injury are also described. The authors present recommendations regarding medical examination, reenactment of the incident to determine the veracity of the caretaker's report, documentation, and working with other agencies. The guide includes a table outlining the characteristics of first- through fourth-degree burns; an evidence worksheet, with instructions, for use at the scene of an immersion burn; and an Investigator's Checklist. (NCJ 162424)

Law Enforcement Response to Child Abuse

Bill Hammond, Law Enforcement Consultant/Trainer, Rockville, Maryland; Kenneth Lanning, M.S., Supervisory Special Agent, Federal Bureau of Investigation Missing and Exploited Children's Task Force, Quantico, Virginia; Wayne Promisel, Detective, Child Services Section, Fairfax County Police Department, Fairfax, Virginia; Jack R. Shepherd, Inspector and Executive Assistant, Investigative Services Bureau, Michigan State Police, East Lansing, Michigan; and Bill Walsh, Lieutenant, Dallas Police Department Youth and Family Crimes Division, Dallas, Texas.

The responsibility for handling cases of child abuse does not rest with law enforcement alone. Social workers, physicians, therapists, and attorneys also play an integral part in these cases. Effective functioning of these professionals as a multidisciplinary team (MDT) requires that they understand each other's roles, responsibilities, and terminology, so that they can cooperate and coordinate their efforts. This guide presents an overview of the role of law enforcement in responding to child abuse cases. It addresses the importance of developing protocols for working with the other MDT professionals and provides information that will help ensure the consistency of response essential to the success of an investigation.

Particular attention is given to working with the medical profession and to the issues involved in placing a child in emergency protective custody. Guidelines are provided for responding after receipt of the referral, acquiring information for the preliminary report, preserving the crime scene, and proceeding during the follow-up investigation and court phase. An "Investigator's Sample Child Sexual Assault Protocol" covers interviewing the victim, obtaining a medical examination, handling evidence, and implementing subpoena procedures. (NCJ 162425)

Criminal Investigation of Child Sexual Abuse

Richard L. Cage, M.A., Detective Sergeant, Montgomery County Police Department, Wheaton, Maryland, and Donna M. Pence, M.A., Special Agent, Tennessee Bureau of Investigation, Nashville, Tennessee.

Investigations of child sexual abuse allegations are complicated by a number of barriers. The child may be reluctant to discuss the abuse; there may be little or no physical or medical evidence; and the toll on the investigator's emotions can be overwhelming. This guide begins with a discussion of these and other barriers and then presents techniques for conducting an investigation that will successfully support or disprove an accusation of child sexual abuse beyond a reasonable doubt in a court of law. A multidisciplinary team approach that brings community agencies, the courts, and healthcare providers into the investigation along with law enforcement and child protective services is recommended.

Guidance is given on interviewing the child, the nonoffending parent or caregiver, siblings and other possible victims, relatives and friends of the victim, and the suspect. Lists of specific questions regarding the child, the suspect, and the child's relationship with the suspect are included in the discussion of the interview of the nonoffending parent. The discussion of the interview of the suspect presents recommendations regarding the timing of the interview and addresses the importance of maintaining an objective, nonjudgmental stance.

The second part of this guide focuses on gathering physical evidence. Search warrants, procedures for conducting searches of the crime scene, and the issue of the medical examination are reviewed. Tables are used to summarize the types of evidence to look for and to present examples of how the child's statements during the interview can provide leads to physical evidence. (NCJ 162426)

Understanding and Investigating Child Sexual Exploitation

Kenneth Lanning, M.S., Supervisory Special Agent, Federal Bureau of Investigation, Missing and Exploited Children's Task Force, Quantico, Virginia, and Robert Hugh Farley, M.S., Detective, Cook County Sheriff's Police Department, Federal Child Exploitation Strike Force, Chicago, Illinois.

The dynamics of the sexual exploitation of children in child sex rings or child pornography differ from those of intrafamilial cases of child sexual abuse. Successful investigation of cases involving child sexual exploitation demands an understanding of preferential sex offenders: serial offenders who prey on children. This guide presents a detailed overview of the highly predictable behavior patterns of these offenders, the ploys they use to manipulate children, and the dynamics of child sex rings and then applies this information to techniques for investigating this type of case.

The authors advocate coordinating the investigation through a multidisciplinary team (MDT) approach and present guidelines for developing an MDT protocol. They discuss issues that must be taken into account when interviewing victims of child sex rings and provide an "Investigator's Checklist" of specific questions regarding the abuse, the offender, other victims, the use of pornography, photographing or videotaping of the victim, other forms of physical evidence, other instances of abuse, and results for the victim.

Procedures are given for investigating and interviewing offenders based on their typical long-term, persistent patterns of behavior. Search warrants and recovery of evidence are discussed, and the guide includes both a sample consent-to-search form and a list of suggested items to recover from suspected offenders. The guide concludes with a brief discussion of how preferential sex offenders make use of online computer services to validate their interests and behavior, organize material, access and distribute child pornography, and find potential new victims. (NCJ 162427)

Forming a Multidisciplinary Team To Investigate Child Abuse

Mark Ells, J.D., Research Assistant Professor, Center on Children, Families, and the Law, University of Nebraska, Lincoln, Nebraska.

Multidisciplinary teams (MDT's) comprising professionals from law enforcement, child protective services, prosecution, medicine, counseling, and related fields have proven to be highly effective in responding to reports of child abuse and neglect. The interagency cooperation, coordination, and collaboration effected through an MDT ensure a timely and appropriate investigation with the least possible trauma to children and families. This guide discusses the need for the MDT approach to investigations, describes several types of MDT, and provides advice on forming and operating an effective team. There are guidelines for convening team participants, writing a mission statement, establishing protocols and confidentiality policies, and evaluating the team's performance. Strategies for promoting teamwork, dealing with conflict, and preventing burnout are also discussed. The guide includes an extensive list of related readings and contact information for organizations that offer training for and technical assistance to MDT's. (NCJ 170020)

Use of Computers in the Sexual Exploitation of Children

Daniel S. Armagh, Director, National Center for Prosecution of Child Abuse, American Prosecutors Research Institute, Alexandria, Virginia;¹ Nick L. Battaglia, Sergeant, San Jose Police Department, San Jose, California; and Kenneth V. Lanning, M.S., Supervisory Special Agent, Federal Bureau of Investigation, National Center for the Analysis of Violent Crime, FBI Academy, Quantico, Virginia.

For criminals involved in the sexual exploitation of children, the computer is a convenient tool for entering the homes of their victims, corresponding with one another, and exchanging images of their illicit activities with child victims. For the law enforcement officers charged with investigating these offenders, cases involving computers present particular challenges and complexities. This guide is designed to help investigators meet those challenges. It describes the behavioral characteristics of sex offenders who focus on children, offers basic information on adapting time-tested investigative techniques to the realm of cyberspace, and discusses the legal issues triggered by investigations of electronic communications.

The first section of the guide shows how understanding the highly predictable behavioral patterns of preferential sex offenders in relation to their use of computers can be critical in determining the most effective investigative strategy. The second section offers guidelines for investigating crimes involving computers, including obtaining a search warrant, handling and securing computer equipment, analyzing the suspect's computer system, and seeking expert assistance. The guide concludes with an examination of the legal principles governing the search and seizure of computer systems, including those involving expert search warrants, exceptions to search warrant requirements, the actions of undercover agents, no-knock warrants, drafting the warrant, and chain of custody. Special tools contained in the guide include a glossary of computer terms, a supplemental reading list, and contact information for organizations and Federal agencies that provide assistance with these investigations. (NCJ 170021)

Overview of the Portable Guides to Investigating Child Abuse: Update 2000	Juvenile Justice Bulletin • February 2000