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
- 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 separatelyjoint 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.
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 (EMTs), 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.
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 childs
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 childs pediatrician about the childs 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.
Important Sources of Information
- Interview siblings, other relatives, neighbors, family friends,
teachers, church associates, and others who may know about the
childs 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 agencys 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.
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 childrens 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.
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
childs 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.
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 childs 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 childs 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 childs pediatrician?
- Does the child attend school or day care? Who is the
childs 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 childs developmental level? (Children
who can barely crawl around cannot injure themselves
by falling from a two-story building.)
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 childs 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 childs 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 childs 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
- If the case involves a combination of sexual and physical abuse,
collecting the childs 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