Critical Steps in Investigating Battered Child Syndrome

Investigators confronted with a case of possible child abuse or child homicide must overcome the unfortunately frequent societal attitude that babies are less important than adult victims of homicide and that natural parents would never intentionally harm their own children. When battered child syndrome is suspected, investigators should always:

  • Collect information about the “acute” injury that led the person or agency to make the report.

  • Conduct interviews with the medical personnel who are attending the child.

  • Review medical records from a doctor, clinic, or hospital.

  • Interview all persons who had access to or custody of the child during the time in which the injury or injuries allegedly occurred. Always interview the caretakers separately—joint interviews can only hurt the investigation.

  • Consider any statements the caretakers made to anyone concerning what happened to the child who required medical attention.

  • Conduct a thorough investigation of the scene where the child was allegedly hurt.

Interviews With Medical Personnel

The investigator must contact all medical personnel who had contact with the family, such as doctors, nurses, admitting personnel, emergency medical technicians (EMT’s), ambulance drivers, and emergency room personnel:

  • Talk with those who provided treatment for the child about what diagnoses and treatments were used. The attending physician will often be able to express at least an opinion that the caretakers’ explanation did not “fit” the severity of the injury. Failure to obtain an opinion from the attending physician should not end the investigation.

  • Speak with any specialists who assisted the attending physician.

  • Have someone knowledgeable about medical terms translate them into laypersons’ terms so that the exact nature of the injuries is clear.

  • Obtain available medical records concerning the injured child’s treatment, including records of any prior treatment. Note: If only one caretaker is suspected of abuse, the nonabusive caretaker may need to sign a release of the records. If both are suspected, most States have provisions that override normal confidentiality rules in the search for evidence of child abuse. Procedures for obtaining these records must be confirmed in each State.

  • Interview the child’s pediatrician about the child’s general health since birth and look for a pattern of suspected abusive injuries.

It is absolutely vital that photographs of the child be taken as soon as possible after the child has been brought to the treatment facility. Most clinics and hospitals have established procedures for photographing injuries in obvious cases of abuse, but when the injuries are more subtle, they may overlook the need for photographs. The investigator should make sure that the medical personnel take and preserve photographs or that the investigating team takes them.

In a child homicide investigation, an autopsy must be performed. Most States mandate that such autopsies be performed when the death of any child under a certain age is undetermined or suspicious. In States without such a statutory mandate, the medical examiner or local prosecutor often has the authority to order an autopsy. This authority should be used whenever there is an unexplained death of a child.

Other Important Sources of Information

  • Interview siblings, other relatives, neighbors, family friends, teachers, church associates, and others who may know about the child’s health and history. People who surround the child and are part of his or her life are sometimes overlooked as sources of background information for a child abuse or homicide prosecution.

  • Review EMT records or 911 dispatch tapes. These records are frequently overlooked and can be a valuable source of information. Families with more than one emergency may in fact be abusing children and may not just be hit by a long streak of “bad luck.”

  • Once the family history is obtained, request any police reports that may be held by law enforcement agencies in the jurisdiction where the family lives. Also check the child welfare agency’s files on the family.

  • Collect additional family history concerning connections between domestic violence and child abuse, substance abuse and child abuse, and other such connections, even apparently unrelated arrests or charges. These records may be helpful in piecing together the complicated picture of what happened to the child this time and who was responsible.

Consultation With Experts

Identifying experts is as important to the child abuse investigator as identifying and cultivating street informants in other types of investigations. If the investigator does not have a basic knowledge of the causes of young children’s injuries, experts may be difficult to identify. Attending training conferences can provide the investigator with a great deal of basic knowledge and help establish a network of experts.

Interviews With Caretakers

A major trait of abusive caretakers is either the complete lack of an explanation for critical injuries or explanations that do not account for the severity of injuries. The investigation must not be dictated solely by caretakers’ early explanations, because once they learn those do not match the medical evidence, they will come up with new ones.

In child homicide cases, for example, investigators will learn quickly about “killer couches,” “killer stairs,” and “killer cribs.” Abusers frequently use these items in their explanations of a child’s death. However, studies show that children do not die in falls from simple household heights; they do not even suffer severe head injuries from such falls.

In nearly every case of actual abuse, the caretakers will not be consistent in their explanations of the injuries over time. Sometimes the changes are apparent from statements abusers have made to others. Additional interviews may be needed to document the changing explanations and to follow up on additional information that the investigation uncovers.

Investigator’s Checklist for
Interviewing Caretakers

Investigators should ask the following questions to ensure a thorough interview with the caretakers.
  • When did the caretakers first notice the child was ill or injured, and what exactly did they observe? What do they believe caused the illness or injury?

  • Who was with the child at the time of the injury or when the child first appeared ill? (Cover as much time as possible up to 3 to 5 days.)

  • What was the child’s apparent health and activity level for the same period up to the time of the illness? Exactly how did the symptoms develop?

  • What is the child’s health history since birth?

  • Has the child been hospitalized or treated for prior injuries or illnesses? If so, what treatment was needed or what caused those injuries?

  • Which caretaker normally disciplines the child, and what form of discipline is used?

  • What is the health of other children in the family?

  • Who is the family doctor or the child’s pediatrician?

  • Does the child attend school or day care? Who is the child’s teacher (or teachers)?

  • Has the child shown any recent behavioral changes that are otherwise unexplained?

  • If the nature of the current injuries is known, how do the caretakers explain what caused such injuries? If no explanation is given, were there times when the child was unsupervised or in the company of others?

  • What is the child’s developmental level? (Children who can barely crawl around cannot injure themselves by falling from a two-story building.)

Crime Scene Investigation

Caretakers’ changes in explanations often mean investigators must visit the home or the scene of the injury more than once. The ideal time to obtain such evidence is immediately after the child’s injury is reported, before caretakers have an opportunity to tamper with the scene.

If the caretakers do not consent to a search of the scene, a search warrant may be necessary. The strongest evidence of the need for such a warrant will be the medical evidence of what probably happened to the child and the caretakers’ inconsistent or absent accounts of the events.

Whatever explanation caretakers offer for the child’s injury or injuries, it is vital that the investigator secure physical evidence. Be thorough in obtaining photographic evidence of the location where the injury took place. Physical evidence and records that must be preserved include:

  • The crib from which the child allegedly fell.

  • The child’s “environment,” including bedding within the bed or crib and other beds in the home.

  • Any toys or objects the child allegedly landed upon.

  • In cases where the child was apparently burned, a record of any sinks, bathtubs, and pots or pans containing water. In addition to testing the temperature of the standing water, test the temperature of water from the water heater and from each tap. Check the temperature setting of the water heater. This may help disprove an allegation that the child accidentally turned on the hot water. Other sources of heat in the home should be documented, regardless of the caretakers’ initial explanation of what burned the child.

  • A complete photographic or videotaped record of the home or other location in which the injuries allegedly occurred. Focus on areas that the caretakers already have identified as the site of the particular trauma (i.e., stairs, beds or crib, or bathtub).

Investigators should be trained by their local crime laboratory personnel on the types of evidence that can and should be processed and preserved in these cases:

  • If the child apparently suffered cigarette burns, collecting cigarette butts found in the home may facilitate analysis of the burn patterns.

  • If the case involves a combination of sexual and physical abuse, collecting the child’s clothing and bedding may allow identification of what happened and who was involved.

  • If the child shows evidence of bite marks, saliva swabbing should be done to allow positive identification of the biter.

  • If the child has suffered a depressed skull fracture, any objects the approximate size of the fracture should be seized for appropriate analysis.