Usually law enforcement officials are the first to be notified of unexpected or sudden deaths among infants or preschool children. After such notification, investigators must evaluate the family's living conditions and the circumstances of the child's death. Documentation by photography, gathering of physical evidence, and reporting must be thorough and objective. Characteristics of the home surroundings which are frequently associated with child abuse include unsanitary home conditions, evidence that the parents are chronic alcoholics, and the presence of hazards to children such as broken glass. Upon initial inspection of the body, the medical examiner should note the nature of clothing, the degree of cleanliness, as well as external characteristics of the child such as height and weight. The state of nutrition as reflected by subcutaneous fatty deposits, the degree of diaper rash and secondary manifestations such as infection, scarring, or loss of pigmentation, and bites are important indications of neglect. Internal examination focuses on trauma, color changes, adhesions, microscopic examination, and x-rays to determine the presence of old injuries. When child abuse is suspected, consideration must be given to the welfare of the remaining siblings, irrespective of the ultimate outcome of criminal litigation. Some physically abused children present no external or internal indication of previous injury. However, careful examination of the body and questioning of the parents reveal previous trauma in approximately 50 percent of these cases. Included in these cases, which most frequently come from middle or upper class homes, are children whose death or injury was unintentional. Usually death is caused by a few severe blows or even shaking of the child, resulting in fatal intraabdominal, subdural, or subarachnoid hemorrhage. Failure to report suspicions of maltreatment following examination by the pathologist is considered a misdemeanor in most States. Photographs 28 references are included. For related documents, see NCJ 69731-39 and 69741-47.