In each of the cases, a thorough examination at autopsy with proper sectioning and microscopy of selected abdominal tissues showed that the acute tissue trauma was superimposed on a background of older, healing injury. This older trauma was characterized by classic histologic elements of tissue repair, including fibroblast proliferation, early scar formation, increased vascularity, and hemosiderin-laden macrophages. Iron and trichrome stains were used to confirm the presence of hemosiderin and fibrosis in all four cases; however, the recognition of fibroblast proliferation and a reactive vascular pattern was best seen on routine hematoxylin and eosin stains. Based on these four cases, the authors recommend taking specific histologic sections in pediatric autopsies that involved inflicted acute blunt force abdominal trauma. These should include the head of the pancreas, soft tissues of the surrounding retroperitoneum, and any acutely injured tissues. These tissues should be examined in order to assess the presence or absence of hemosiderin-laden macrophages, granulation tissue, reactive myofibroblasts, edema, collagen fibrosis, or vascular proliferation. In light of the known timing of changes in the healing process, identification of specific changes may allow the forensic pathologist to determine whether or not the same areas which were acutely injured had sustained prior trauma. If such prior trauma is found, it may correlate with other indicators of chronic abuse, including cutaneous injuries, skeletal trauma, intracranial injuries, or malnutrition. 6 figures and 18 references