U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention

Portable Guides to

Investigating Child Abuse

Recognizing

When a Child’s

Injury or Illness

Is Caused by

Abuse
Foreword

Investigation of potential incidents of child abuse is a critical

and sensitive matter. Protection of children and fairness to

parents are complementary, not mutually exclusive ends.

Balancing these interests is a very difficult and challenging

law enforcement responsibility.

It is an important part of the investigative process that physical

and sexual abuse of children not be camouflaged as accidental

injury. To determine whether a child’s injuries are accidental

or intentional requires careful investigation, and this guide

provides many practical pointers toward that end.

Original Printing June 1996

Second Printing June 1997

Third Printing March 2000

Fourth Printing December 2002

NCJ 160938
1

n recent years the public’s increased awareness

and reports of suspected child abuse have put

pressure on law enforcement to improve their

investigations of such cases. This

was underscored in late 1987

when a New York City

toll collector observed a

small girl covered with

bruises in the rear of a

car. The collector radioed

the New York State

Police, who stopped the car.

The child’s foster father, an attorney, explained

to police that the bruises were accidental, and he

was released. A week later, the child was dead from

a beating.

Law enforcement personnel frequently must determine

whether a child’s accident or illness was caused by a

parent or caretaker. However, it is often difficult even

for medical personnel to discriminate between injuries

and illnesses that are accidental and those that are not.

The following information can help law enforcement

personnel to determine if it is likely that abuse has

occurred.

I
2

Could This Be Child Abuse?

Investigators must determine whether the explanation for an

injury is believable. Police should begin their investigation by

asking the caretaker for an explanation of the child’s bruises

or injuries. This is best done by asking the question: How did

the accident happen?

All bruises must be investigated. If bruises are found on two

or more planes of a child’s body, investigators should be even

more suspicious. For example, a child has bruises on his

buttocks and stomach. The caretaker’s explanation is that the

child fell backward in the living room of the family home. This

might explain the bruises on the buttocks, but not the stomach

bruises. If a discrepancy exists between the reported cause of

an injury and the injuries seen, law enforcement personnel

should investigate further. They should also keep in mind the

following points:

✹ All other children in the home should be examined for possible

signs of child abuse.

✹ Victims of physical abuse often have been intimidated and

will usually support the abuser’s version of how their injuries

occurred to avoid further injury. They also feel that the abuse

was just punishment because they were bad.

✹ A physical examination of the child in suspected cases of

maltreatment must be done and the data recorded precisely.

✹ Laboratory data should be obtained to support or refute the

evidence of abuse.

✹ If the reported history of an injury or injuries changes during

the course of an investigation, or if there is conflict between two

adult caretakers as to the cause of injury, the likelihood of child

maltreatment increases.

✹ The demeanor of the child’s parents or caretakers is sometimes

revealing. For example, the mother’s assessment of her pregnancy,

labor, and delivery will often provide an insight into her attitude

about her child as well as give an indication of whether there is

something about the child that is influencing her behavior.
3

✹ Investigators should ask questions in an unobtrusive manner;

for example:

● Was this a planned pregnancy?

● Did you want the baby?

● Do you like the baby?

● How did the accident happen?

● What were you doing just before the accident?

● Who was at home at the time of the accident?

● What do you feed the baby? How often? Who feeds the baby?

✹ Information about a child’s birth and his or her neonatal and

medical history are critical elements in investigations. Hospital

records can confirm or eliminate the existence of birth injuries.

✹ Any child may be abused, and child abuse occurs in all levels of

society. However, there are some factors that increase a child’s

risk of abuse. These include:

● Premature birth or low birth weight.

● Being identified as “unusual” or perceived as “different” in terms

of physical appearance or temperament.

● Having a variety of diseases or congenital abnormalities.

● Being physically, emotionally, or developmentally disabled

(e.g., mentally retarded or learning disabled).

● Having a high level of motor activity, being fussy or irritable, or

exhibiting behavior that is different from the parents’ expectations.

● Living in poverty or with families who are unemployed.

● Living in environments with substance abuse, high crime, and

familial or community violence.
4

The following are provided to help

law enforcement personnel determine

which injuries and illnesses in children

are likely to be the result of abuse.

However, it is also very important for

law enforcement to work closely with

physicians to determine the nature of

all injuries.

Repetitive Accidents

Multiple bruises, wounds, abrasions, or other skin lesions

in varying states of healing may indicate repetitive physical

assault. Such repetitive accidents or injuries may indicate that

abuse is occurring. A careful examination of the circumstances

and types of injuries and an assessment of the child and family

should be carried out by a professional skilled in family

dynamics, usually the social worker investigating a report of

suspected abuse. However, a police officer from the juvenile

division may in some circumstances be responsible for this,

rather than a social worker.

Cutaneous (Skin) Injuries

The most common manifestations of nonaccidentally inflicted

injuries are skin injuries. Several characteristics help to

distinguish nonaccidental skin injuries from accidental ones,

including their location and pattern, the presence of multiple

lesions of different ages, and the failure of new lesions to

appear after hospitalization. Law enforcement personnel

should be sure to obtain a complete history of all injuries from

the caretaker.

Bruises

Bruises are due to the leakage of blood into the skin tissue

that is produced by tissue damage from a direct blow or a

crushing injury. Bruising is the earliest and most visible sign

of child abuse. Early identification of bruises resulting from

child abuse can allow for intervention and prevent further

abuse.
5

Bruises seen in infants, especially on the face and buttocks,

are more suspicious and should be considered nonaccidental

until proven otherwise. Injuries to children’s upper arms

(caused by efforts to defend themselves), the trunk, the front

of their thighs, the sides of their faces, their ears and neck,

genitalia, stomach, and buttocks are also more likely to be

associated with nonaccidental injuries. Injuries to their shins,

hips, lower arms, forehead, hands, or the bony prominences

(the spine, knees, nose, chin, or elbows) are more likely to

signify accidental injury.

Age Dating of Bruises

It is important to determine the ages of bruises to see if their

ages are consistent with the caretaker’s explanation of the

times of injury. Age dating of bruises can often be determined

by looking at the color of the bruise. The ages and colors of

bruises may therefore show if more than one injury is present.

Table 1 shows the ages associated with the colors of bruises.

Table 1

Determining the Age of a Bruise by Its Color

Color of Bruise

Red (swollen, tender)

Blue, purple

Green

Yellow

Brown

No further evidence of bruising

Age of Bruise

0–2 days

2–5 days

5–7 days

7–10 days

10–14 days

2–4 weeks
6

For example, a 2-year-old boy, not toilet trained, has several

yellow-to-brown bruises on his buttocks. The caretaker’s

explanation for the bruises is that the child tripped in the

hallway the day before and fell on his buttocks. This would

be suspicious because:

✹ Children seldom bruise their buttocks in accidental falls.

✹ Bruises on the buttocks are in the primary target zone for

nonaccidental injury.

✹ The child’s diaper (whether disposable or cloth), plastic pants,

and clothing would have afforded some protection to his buttocks.

✹ If the injuries causing the bruises were sustained the previous

day, the bruises should be red to purple.

Another child might have both bright red and brown bruises.

The caretaker maintains that all of the bruises were the result

of a fall that day. However, the bright red color indicates fresh

bruises, while the brown bruises are older. The caretaker’s

explanation is, therefore, suspicious, and separate explanations

must be obtained for each bruise.

Bruise Configurations

Bruises will sometimes have a specific configuration. This

may enable law enforcement officers to determine whether

bruises are accidental or nonaccidental. One of the easiest

ways to identify the weapon used to inflict bruises is to ask

the caretaker: How were you punished as a child?

The pattern of a skin lesion may suggest the type of instrument

used. Bruise or wound configurations from objects can be

divided into two main categories: those from “fixed” objects,

which can only strike one of the body’s planes at a time, and

those from “wraparound” objects, which follow the contours

of the body and strike more than one of the body’s planes.

Hands can make either kind of bruise, depending on the size

of the offender’s hands and the size of the child. Examples of

fixed and wraparound objects include:

✹ Fixed objects: coat hangers, handles, paddles.

✹ Wraparound objects: belts, closed-end (looped) cords, open-end

cords. (Closed-end cords leave a bruise in parallel lines; open-end

cords leave a bruise in a single line.)
7

Natural or Normal Bruising

Injuries inflicted by human hands, feet, or teeth or those

inflicted by belts, ropes, electrical cords, knives, switches,

gags, or other objects will often leave telltale marks (e.g., gags

may leave down-turned lesions at the corners of the mouth).

These marks may also help in the investigative process. For

example, the size of bite marks may help to determine the

biter’s approximate age; their shape may help identify whose

teeth made the marks. In some cases, however, bruises are

acquired innocently, through play and accidental falls, or

when a child has a defect in his or her clotting mechanism.

For example, a baby is brought to the hospital with purple

bruises on several body surfaces. The parents were unable

to provide an explanation other than that the baby “bruised

easily.” Blood tests later revealed that the baby was a

hemophiliac; hemophilia is associated with bruising easily,

due to blood clotting problems. There is usually a history

of bruising easily in families with such inherited diseases.

Other incidents of “easy bruising” in children can be explained

by a low blood platelet count. Multiple bruises can occur

in children with leukemia. Diseases causing easy bruising,

however, are rare, and inflicted bruises are much more common.

The medical diagnosis of clotting disorders requires blood

tests and interpretation of those tests by qualified physicians.

Therefore, law enforcement officers should try to determine

if bruises are the result of an accident or due to physical abuse.

Police must also remember never to jump to conclusions and

to make a complete investigation of all aspects of suspected

child abuse. However, their first duty is to secure the safety

of the child quickly.

Mongolian spots (a kind of birthmark) also resemble bruises

but can be distinguished by their clear-cut margins, the fact

that they do not fade, and their steel gray-blue color. Mongolian

spots may be found anywhere on the body (but are typically

found on the buttocks and lower back). In addition, they are

commonly found in African Americans, Asians, and Hispanics.

Investigators should await medical reports when investigating

such marks.
8

Burns

As shown in table 2, certain characteristics of the history,

location, or pattern of burns may indicate whether they were

nonaccidental.

Indications That Burns May Not

Have Been Accidental

History

✹ The burns are attributed to siblings.

✹ An unrelated adult brings the child in for medical care.

✹ Accounts of the injury differ.

✹ Treatment is delayed for more than 24 hours.

✹ There is evidence of prior “accidents” or an absence

of parental concern.

✹ The lesions are incompatible with the history.

Location

✹ The burns are more likely to be found on the buttocks, in the

anogenital region (the area between the legs, encompassing

the genitals and anus), and on the ankles, wrists, palms, and

soles.

Pattern

✹ The burns have sharply defined edges. For example, in

immersion burns, the line of immersion gives the appearance

of a glove or stocking on the child’s hand or foot.

✹ The burns are full thickness (all of the skin, and possibly

muscle and bone as well, is destroyed).

✹ The burns are symmetrical.

✹ The burns are older than the reported history indicates.

✹ The burns have been neglected or are infected.

✹ There are numerous lesions of various ages.

✹ The burn patterns conform to the shape of the implement

used.

✹ The degree of the burns is uniform (usually indicating forced

contact with a hot, dry object), and they cover a large area.

Table

Distinguishing Accidental
9

Indications That Burns Are More

Likely To Be Accidental

Location

✹ The burns are usually found on the front of the body. They

occur in locations reflecting the child’s motor activity, level

of development, and the exposure of the child’s body to the

burning agent.

Pattern

✹ The burns are of multiple depths interspersed with unburned

areas and are usually less severe (such as splash burns).

✹ The burns are of partial thickness; that is, only part of the

skin has been damaged or destroyed.

✹ The burns are asymmetrical.

✹ Apparently only one traumatic event has occurred, because

the skin injuries are all of the same age.

History

✹ The history of the mechanism of the burns is compatible

with the observed injury.

2

From Nonaccidental Burns
10

Poisoning

J.A. Bay’s exhaustive review of the world’s literature of

reported cases of nonaccidental poisoning as a form of child

abuse identified certain agents that are commonly used

by perpetrators (“Conditions Mistaken for Child Sexual

Abuse,” in Reece, R.M. (ed.): Child Abuse: Medical Diagnosis

and Management). The most frequently used agents included

barbiturates, psychoactive drugs, tranquilizers, insulin, ipecac,

arsenic, laxatives, salt, water, alcohol, marijuana, and opiates.

The children poisoned by such agents display a variety of

presenting signs and symptoms, but nearly all have major

changes in their mental status, ranging from irritability,

listlessness, lethargy, stupor, and coma to convulsions. The

peak age for accidental poisoning is 2 to 3 years, and it is rare

under the age of 1 or over the age of 6. The usual history of

nonaccidental poisoning is that either the ingestion was not

witnessed or that it was administered by a sibling or another

child. In addition, the history may change over time.

Head Injuries

Many fatalities from child abuse involve serious head injuries.

Subdural hematomas due to child abuse are most common in

children less than 24 months of age, with the peak incidence

at about 6 months. The signs and symptoms of subdural

hematomas may either be nonspecific, including irritability,

lethargy, or a disinclination to eat, or there may be more

classic signs of raised intracranial pressure such as vomiting,

seizures, stupor, or coma. A subdural hematoma associated

with a skull fracture is due to a direct impact to the head

and ordinarily leaves external marks. It may be associated

with shaking the baby violently or with an extreme blow to

the head, such as occurs when children are thrown against

a hard object.

Retinal hemorrhages strongly suggest whiplash or shaking

as the origin of the injury. The presence of bilateral subdural

hematomas is also positively correlated with whiplash or

shaking. Therefore, law enforcement personnel need to

investigate whether these were nonaccidental injuries.
11

Hair pulling as a means of discipline may be responsible for

hair loss or baldness (alopecia).

Eye Injuries

✹ External eye injuries are so common in children that they are

seldom clear-cut evidence of abuse.

✹ Two black eyes seldom occur together accidentally.

✹ The “raccoon eyes” associated with accidental and nonaccidental

fractures at the base of the skull may look similar to each

other, but raccoon eyes from nonaccidental trauma usually are

associated with more swelling and skin injury. The history helps

distinguish between them.

✹ Hyphema, the traumatic entry of blood into the front chamber

of the eye, may be the result of a nonaccidental injury caused by

striking the eye with a hard object, such as a belt buckle. The

child will complain of pain in the eye and have visual problems.

✹ Retinal hemorrhages are the hallmark of shaken baby syndrome

and are only rarely associated with some other mechanism of

injury.

✹ Nonaccidental trauma must always be considered in a child under

3 years of age who has retinal hemorrhages or any traumatic

disruption of the structures of the globe of the eye (e.g., the lens

or retina) or the skin around the eye.

Internal Injuries

✹ Internal organ injuries are second only to head trauma as the

most common causes of death in child abuse.

✹ Nonaccidental internal injuries usually involve structures below

the diaphragm.

✹ Accidental abdominal injuries usually involve a long fall to a

flat surface, a motor vehicle accident or, rarely, are the result

of contact sports. Accidental abdominal injuries usually involve

older children who are brought to medical attention immediately,

whereas children with nonaccidental abdominal injuries will

be younger, and a delay in seeking medical attention is more

common. Nonaccidental abdominal injuries more commonly

involve hollow organs (e.g., the gut and stomach) than accidental

injuries, but the liver, spleen, and pancreas can all suffer

nonaccidental injury. For some reason, the kidneys are rarely

injured.
12

✹ Although there are signs and symptoms, in most cases of

abdominal organ injury there are no external signs of trauma.

This is due to the pliability of the abdominal wall and its ability

to absorb trauma without showing bruises.

✹ Unusual clinical findings may indicate abuse.

✹ In school-age children, trauma to the pancreas is quite infrequent

and usually involves an injury caused by bicycle handlebars or

traffic accidents. In infants and toddlers under the age of 3, child

abuse must be strongly suspected, since the pancreas is so deep

in the abdomen that it is protected from all trauma except blunt

force trauma.

Sudden Infant Death Syndrome

Sudden infant death syndrome (SIDS) is the “sudden death

of an infant under one year which remains unexplained after

a thorough case investigation, including performance of a

complete autopsy, examination of the death scene, and review

of the clinical history” (Willinger, M., et al., “Defining the

Sudden Infant Death Syndrome (SIDS): Deliberations

of an Expert Panel Convened by the National Institute of

Child Health and Human Development,” Pediatric Pathology

11:677–684, 1991). SIDS is unexpected, usually occurring

in apparently healthy infants ages 1 month to 1 year. Most

deaths from SIDS occur by the end of the sixth month, with

the greatest number taking place between ages 2 and 4 months.

SIDS is the leading cause of death in the United States among

infants between the ages of 1 month and 1 year, and is second

only to congenital anomalies as the overall leading cause of

death for all infants under 1 year of age (National Sudden

Infant Death Syndrome Resource Center, 1993).

In sudden, unexplained infant deaths, investigators, including

medical examiners and coroners, use the special expertise

of forensic medicine (the application of medical knowledge

to legal problems) to arrive at a diagnosis. A definitive SIDS

diagnosis cannot be made without a thorough autopsy—

including microscopic examination of tissue samples and vital

organs—that fails to point to any other possible cause

of death. Also, if the cause of the infant’s death is ever to

be uncovered, it will be from evidence gathered during a

thorough pathological examination. Often, the cause of an
13

infant’s death can only be determined by carefully collecting

and evaluating information from the death scene and conducting

forensic tests. Investigators should also carefully review

the child’s and child’s family’s history of previous illnesses,

accidents, or behaviors. Review of these details may further

corroborate what is detected in the autopsy or death scene

investigation. Investigators should be sensitive, yet thorough.

Criteria for distinguishing SIDS from death caused by child

abuse are presented in table 3. The following is a list of key

points relative to SIDS:

✹ SIDS is a diagnosis of exclusion following a thorough autopsy,

death scene investigation, and comprehensive review of the child

and his or her family’s case history.

✹ SIDS is a definite medical entity and is the major cause of death

in infants after the first month of life, with most deaths occurring

between the ages of 2 and 4 months.

✹ SIDS victims appear to be healthy prior to death.

✹ SIDS currently cannot be predicted or prevented, even by a

physician.

✹ SIDS deaths appear to cause no pain or suffering; death occurs

very rapidly, usually during sleep.

✹ SIDS is not child abuse.

✹ SIDS is not caused by external suffocation.

✹ SIDS is not caused by vomiting and choking or by minor illnesses

such as colds or infections.

✹ SIDS is not caused by the diphtheria/pertussis/tetanus (DPT)

vaccine or other immunizations.

✹ SIDS is not contagious.

✹ SIDS is not the cause of every unexplained infant death.
14

Consistent With SIDS Less Consistent With SIDS Highly Suggestive or

Diagnostic of Child Abuse

Circumstances surrounding death

An apparently healthy infant fed and put Infant found not breathing. EMS transports History is not typical of SIDS† or there is

to bed. Found lifeless (silent death). EMS† to hospital. Infant lives hours to days. a discrepant or unclear history. Prolonged

resuscitation unsuccessful. History of substance abuse or family illness. interval between bedtime and death.

Age of child

Peak: 2–4 months (90% < 7 months). 8–12 months >12 months

Range: 1–12 months

Physical examination and laboratory studies at time of death

Bloody, watery, frothy, or mucous nasal Organomegaly of the viscera (enlargement Skin injuries. Traumatic injuries to body

discharge. PM† lividity in dependent areas of the organs). Diagnostic signs of a disease parts: mucous membranes of the eyelids,

(portions of the body that are lower—due process (by PE†, laboratory tests, x-ray). fundi (part of the eye opposite the pupil),

to gravity, the blood settles). Sometimes scalp, inside of the mouth, ears, neck,

Table 3

Criteria for Distinguishing SIDS From Fatal Child Abuse and Other Medical Conditions*
15

there are marks on pressure points (places trunk, anus or genitals, and extremities.

where a blood vessel runs near a bone, Evidence of malnutrition, neglect, or

such as where pressure is applied to stop fractures may also be present.

bleeding). No skin trauma. Apparently

well-cared-for baby.

History of pregnancy, delivery, and infancy

Prenatal care ranged from minimal to Prenatal care was minimal to maximal Pregnancy was unwanted. Little or no

maximal. Frequently, mothers used (therefore, it has no significance in prenatal care. Mother arrived late at

cigarettes during pregnancy. Some victims distinguishing SIDS from non-SIDS hospital for delivery, or birth occurred

were premature or had LBW†. Newborns deaths). Child has history of recurrent outside of hospital. Little or no well-baby

showed minor defects with regard to their illnesses and/or multiple hospitalizations care. No immunizations. Mother used

feeding and general temperament. Less (“sickly” or “weak” baby). Previous cigarettes, drugs, and/or alcohol during

height and weight gain after birth. Being specific diagnosis of organ system disease. and after pregnancy. Child described as

a twin or a triplet. Possible history of hard to care for or to “discipline.”

spitting, GE† reflux, thrush, pneumonia, Deviant feeding practices were used.

illnesses requiring hospitalization,

accelerated breathing or heartbeat,

(bluish) discoloration of skin due to lack

of oxygen in the blood. Usually no signs

of difficulty before death.
16

Consistent With SIDS Less Consistent With SIDS Highly Suggestive or

Diagnostic of Child Abuse

Death scene investigation

Crib or bed in good repair. No dangerous Defective crib or bed or inappropriate Chaotic, unsanitary, and crowded living

bedclothes, toys, plastic sheets, pacifier sheets, pillows, or sleeping clothes. conditions. Evidence of drug or alcohol

strings, or pillows stuffed with pellets. No Presence of dangerous toys, plastic sheets, use by caretakers. Signs of a struggle in

cords, bands, or other possible means of pacifier cords, pellet-stuffed pillows. crib or other equipment. Blood-stained

entanglement. An accurate description was Evidence that child did not sleep alone. bedclothes. Evidence of hostility, discord,

provided of the child’s position, including Poor ventilation and heat control. or violence between caretakers.

whether there was head or neck entrapment. Presence of toxins or insecticides. Admission of harm, or accusations by

Normal room temperature. No toxins or Unsanitary conditions. caretakers.

insecticides present. Good ventilation,

furnace equipment.

Previous infant deaths in family

No previous unexplained or unexpected One previous unexpected or unexplained More than one previous unexplained or

infant deaths. infant death. unexpected infant death.

Table 3 continued

Criteria for Distinguishing SIDS From Fatal Child Abuse and Other Medical Conditions*
17

Autopsy findings

No adequate cause of death at PM. Normal Subtle changes in liver, adrenal glands, and Traumatic cause of death (IC† or visceral

skeletal survey, toxicological findings, the heart muscle (myocardium). bleeding). External bruises, abrasions,

chemistry studies (blood sugar may be high, burns. Evidence of malnutrition, fractures,

normal, or low), microscopic examination, or scalp bruises. Abnormal body chemistry

and metabolic screen. Presence of changes values: Na†, Cl†, K†, BUN†, sugar, liver and

in certain organs thought to be more pancreatic enzymes, and CPK†. Abnormal

commonly seen in SIDS than in non-SIDS toxicological findings.

deaths. Occasionally, subtle changes in

liver, including fatty change and blood

forming in the liver (not a normal site for

blood production).

Previous involvement of child protective services or law enforcement

None. One. Two or more. One or more family members

arrested for violent behavior.

*Adapted from Reece, R.M. Fatal child abuse and sudden infant death syndrome: A critical diagnostic decision. Pediatrics 91(2):423, 1993. Reproduced by permission of Pediatrics.

†Abbreviations: BUN, blood urea nitrogen; Cl, chlorine; CPK, creatinine phosphokinase; EMS, emergency medical services; GE, gastroesophageal; IC, intracranial; K, potassium;

LBW, low birth weight; Na, sodium; PE, physical examination; PM, postmortem; SIDS, sudden infant death syndrome.
18

Investigator’s Checklist for Use in Suspected

Cases of Physical Child Abuse

Far too often police investigating a child’s injuries will

let their emotions interfere. It should be remembered

that the child abuse investigation process, if performed

correctly, will ultimately determine which injuries

were nonaccidental. The following are some important

questions and issues to be considered when investigating

a suspected case of child abuse.

❑ Begin by asking questions about the child’s family history,

substance abuse or other environmental factors in the

home, and the parents’ marital status, employment history,

or unrealistic expectations of the child.

❑ How could the child’s behavior or the caretaker’s stress

have contributed to the crisis?

❑ Could the child do what the caretakers told you he or she

did?

❑ Is the child a “target” child (a child perceived by the parent(s)

as having negative characteristics), or are there target

children present?

❑ Was there any delay in treatment or was hospital

“shopping” involved?

❑ What are the locations, configurations, and distributions of

the bruises, welts, lacerations, abrasions, or burns?

❑ Do the injuries appear to have been caused by the hands or

an instrument? Can you determine what instrument might

have been used?

❑ Are multiple injuries (in various stages of healing) present?

❑ Are the injuries within the primary target zone (the back,

from the neck to the back of the knees and including the

shoulders and arms) and on more than one leading edge

(the outside of the arm or leg, etc.) of the body?

❑ Can you determine the positions of the offender and the

child during the attack?

❑ Is there any evidence of attempts to hold the child in a

certain position or at a certain angle during the attack?

Are there such control marks on the wrists, forearms,

or biceps?

❑ Was a careful check made for injuries on the head, mouth,

ears, and nose?
19

Contributing Authors

Robert Hugh Farley, M.S.

Commanding Officer, Cook County

Sheriff’s Police Department

Child Exploitation Unit

1401 Southmaybrook Drive

Maywood, IL 60153

708–865–4875

708–865–4818 (fax)

E-mail: rhfarley@hotmail.com

Robert M. Reece, M.D.

Clinical Professor of Pediatrics

Tufts University School of Medicine

Boston, Massachusetts

and

Director, Institute for Professional Education

Massachusetts Society for the Prevention of

Cruelty to Children (MSPCC)

399 Boylston Street

Boston, MA 02116

617–587–1512

617–587–1582 (fax)

E-mail: breece@mspcc.org

Supplemental Reading

General

Duhaime AC et al. Head injury in very young children:

Mechanisms, injury types and ophthalmic findings in 100

hospitalized patients younger than 2 years of age. Pediatrics

90:179, 1992.

Duhaime AC et al. The shaken baby syndrome: A clinical,

pathological and biomechanical study. Journal of Neurosurgery

66:409, 1987.

Hight DW et al. Inflicted burns in children. Journal of the

American Medical Association 242:517, 1979.

Kessler DB, Hyden P. Physical, Sexual, and Emotional Abuse

of Children. (CIBA–GEIGY Clinical Symposia, Vol. 43, No. 1).

Summit, NJ: Pharmaceuticals Division, CIBA–GEIGY

Corporation, 1991.
20

Kleinman PK (ed). Diagnostic Imaging of Child Abuse. Baltimore:

Williams & Wilkins, 1987.

Ledbetter DJ et al. Diagnostic and surgical implications of

child abuse. Archives of Surgery 123:1101, 1988.

Ludwig S, Kornberg A (eds). Child Abuse: A Medical Reference.

2d ed. New York: Churchill Livingstone, 1992.

McNeese MC, Hebeler JR. The Abused Child: A Clinical

Approach to Identification and Management. (CIBA Clinical

Symposia, Vol. 29, No. 5). Summit, NJ: CIBA Pharmaceutical

Company, Division of CIBA–GEIGY Corporation, 1977.

Merten DF et al. The abused child: A radiological reappraisal.

Radiology 146:377, 1983.

Pascoe JM et al. Patterns of skin injury in nonaccidental and

accidental injury. Pediatrics 64:245, 1979.

Reece RM (ed). The Quarterly Child Abuse Medical Update.

Published by the Institute for Professional Education of the

Massachusetts Society for the Prevention of Cruelty to Children.

Abstracts of the latest information on the subject of child abuse

from more than 40 medical journals.

Reece RM (ed). Child Abuse: Medical Diagnosis and Management.

Malvern, PA: Lea and Febiger, 1994.

Reece RM, Grodin M. Recognition of nonaccidental injuries.

Pediatric Clinics of North America 32:41–60, 1985.

Saywitz KJ. Developmental considerations for forensic

interviewing. The Interviewer 3:15, 1990.

Shepherd J, Dworn B, Farley R, Russ B, Tressler P. Child

Abuse and Exploitation: Investigative Techniques. U.S. Department

of Justice, Office of Justice Programs, Office of Juvenile

Justice and Delinquency Prevention, 1992.

Whitcomb D. When the Victim Is a Child. 2d ed. Washington,

DC: U.S. Department of Justice, Office of Justice Programs,

National Institute of Justice, 1992.

Worlock T et al. Patterns of fractures in accidental and nonaccidental injury in children. A comparative study. British

Medical Journal 293:100, 1986.
21

Sudden Infant Death Syndrome

National Sudden Infant Death Syndrome Clearinghouse.

Death Investigations and Sudden Infant Death Syndrome: A Selected

Annotated Bibliography. U.S. Department of Health and Human

Services, Public Health Service, Health Resources and

Services Administration, Maternal and Child Health Bureau,

September 1991.

National Sudden Infant Death Syndrome Clearinghouse.

The Professional’s Role in Sudden Infant Death Syndrome: A Selected

Annotated Bibliography. U.S. Department of Health and Human

Services, Public Health Service, Health Resources and

Services Administration, Maternal and Child Health Bureau,

September 1991.

National Sudden Infant Death Syndrome Resource Center.

Sudden Infant Death Syndrome Research: A Selected Annotated

Bibliography for 1993. McLean, VA: U.S. Department of

Health and Human Services, Public Health Service, Health

Resources and Services Administration, Maternal and Child

Health Bureau, May 1994.

National Sudden Infant Death Syndrome Resource Center.

Sudden Infant Death Syndrome Risk Factors: A Selected Annotated

Bibliography for 1989–1993. McLean, VA: U.S. Department of

Health and Human Services, Public Health Service, Health

Resources and Services Administration, Maternal and Child

Health Bureau, May 1994.

National Sudden Infant Death Syndrome Resource Center.

Sudden Infant Death Syndrome: Trying To Understand the Mystery.

McLean, VA: U.S. Department of Health and Human

Services, Public Health Service, Health Resources and

Services Administration, Maternal and Child Health Bureau,

February 1994.

National Sudden Infant Death Syndrome Resource Center.

What is SIDS? (Information Sheet). McLean, VA: U.S.

Department of Health and Human Services, Public Health

Service, Health Resources and Services Administration,

Maternal and Child Health Bureau, May 1993.
22

Willinger M, James LS, Catz C. Defining the sudden infant

death syndrome (SIDS): Deliberations of an expert panel

convened by the National Institute of Child Health and

Human Development. Pediatric Pathology 11:677–684, 1991.

Organizations

General

Missing and Exploited Children’s Training Programs

Fox Valley Technical College

Criminal Justice Grants Department

P.O. Box 2277

1825 North Bluemound Drive

Appleton, WI 54913–2277

800–648–4966

920–735–4757 (fax)

dept.fvtc.edu/ojjdp

Participants are trained in child abuse and exploitation investigative

techniques, covering the following areas:

✹ Recognition of signs of abuse.

✹ Collection and preservation of evidence.

✹ Preparation of cases for prosecution.

✹ Techniques for interviewing victims and offenders.

✹ Liability issues.

Fox Valley also offers intensive special training for local child investigative

teams. Teams must include representatives from law enforcement,

prosecution, social services, and (optionally) the medical field. Participants

take part in hands-on team activity involving:

✹ Development of interagency processes and protocols for enhanced

enforcement, prevention, and intervention in child abuse cases.

✹ Case preparation and prosecution.

✹ Development of the team’s own interagency implementation plan for

improved investigation of child abuse.

National Center for Prosecution of Child Abuse

American Prosecutors Research Institute (APRI)

99 Canal Center Plaza, Suite 510

Alexandria, VA 22314

703–549–9222

703–836–3195 (fax)

www.ndaa-apri.org/apri/programs/ncpca/index.html
23

The National Center for Prosecution of Child Abuse is a nonprofit and

technical assistance affiliate of APRI. In addition to research and technical

assistance, the Center provides extensive training on the investigation and

prosecution of child abuse and child deaths. The national trainings include

timely information presented by a variety of professionals experienced in

the medical, legal, and investigative aspects of child abuse.

Sudden Infant Death Syndrome

American SIDS Institute

2480 Windy Hill Road, Suite 380

Marietta, GA 30067

800–232–7437

770–612–1030

www.sids.org

Association of SIDS and Infant Mortality Programs

c/o Minnesota SIDS Center

Children’s Hospitals and Clinics

2525 Chicago Avenue South

Minneapolis, MN 55404

612–813–6285

www.asip1.org

Center for Infant & Child Loss

University of Maryland School of Medicine

630 West Fayette Street, Room 5–691

Baltimore, MD 21201

800–808–7437

www.infantandchildloss.org

National SIDS Resource Center

2070 Chain Bridge Road, Suite 450

Vienna, VA 22182

703–821–8955, ext. 249

www.sidscenter.org

SIDS Alliance

1314 Bedford Avenue, Suite 210

Baltimore, MD 21208

800–221–7437

410–653–8226

www.sidsalliance.org/index/default.asp
24

Other Titles in This Series

Currently there are 12 other Portable Guides to Investigating

Child Abuse. To obtain a copy of any of the guides listed below

(in order of publication), contact the Office of Juvenile Justice

and Delinquency Prevention’s Juvenile Justice Clearinghouse

by telephone at 800–638–8736 or e-mail at puborder@ncjrs.org.

Sexually Transmitted Diseases and Child Sexual Abuse, NCJ 160940

Photodocumentation in the Investigation of Child Abuse, NCJ 160939

Diagnostic Imaging of Child Abuse, NCJ 161235

Battered Child Syndrome: Investigating Physical Abuse and Homicide,

NCJ 161406

Interviewing Child Witnesses and Victims of Sexual Abuse,

NCJ 161623

Child Neglect and Munchausen Syndrome by Proxy, NCJ 161841

Criminal Investigation of Child Sexual Abuse, NCJ 162426

Burn Injuries in Child Abuse, NCJ 162424

Law Enforcement Response to Child Abuse, NCJ 162425

Understanding and Investigating Child Sexual Exploitation,

NCJ 162427

Forming a Multidisciplinary Team To Investigate Child Abuse,

NCJ 170020

Use of Computers in the Sexual Exploitation of Children, NCJ 170021

Southwest SIDS Research Institute

Brazosport Memorial Hospital

100 Medical Drive

Lake Jackson, TX 77566

800–245–7437

409–297–4411

www.swsids.hicd.com/index.html
Additional Resources

American Bar Association

(ABA) Center on Children

and the Law

Washington, DC

202–662–1720

www.abanet.org/child/

home.html

American Humane Association

Englewood, Colorado

800–227–4645

303–792–9900

www.americanhumane.org

American Medical Association

(AMA)

Chicago, Illinois

312–464–5000

www.ama-assn.org

American Professional Society

on the Abuse of Children

(APSAC)

Oklahoma City, OK

405–271–8202

www.apsac.org

Federal Bureau of Investigation

(FBI)

202–324–3000

www.fbi.gov

National Center for the

Analysis of Violent Crime

www.fbi.gov/hq/isd/cirg/

ncavc.htm

Crimes Against Children

Program

www.fbi.gov/hq/cid/cac/

crimesmain.htm

Juvenile Justice Clearinghouse

(JJC)

Rockville, Maryland

800–638–8736

ojjdp.ncjrs.org/about/

clearh.html

Kempe Children’s Center

Denver, Colorado

303–864–5252

www.kempecenter.org

Missing and Exploited

Children’s Training Program

Fox Valley Technical College

Appleton, Wisconsin

800–648–4966

dept.fvtc.edu/ojjdp

National Association of

Medical Examiners

St. Louis, Missouri

314–577–8298

www.thename.org

National Center for Missing

and Exploited Children

(NCMEC)

Alexandria, Virginia

800–THE–LOST

703–274–3900

www.missingkids.com

National Center for Prosecution

of Child Abuse

Alexandria, Virginia

703–549–9222

www.ndaa-apri.org/apri/

programs/ncpca/index.html

National Children’s Alliance

Washington, DC

800–239–9950

202–452–6001

www.nncac.org

National Clearinghouse

on Child Abuse and

Neglect Information

Washington, DC

800–394–3366

703–385–7565

www.calib.com/nccanch/

National SIDS Resource Center

Vienna, Virginia

703–821–8955

www.sidscenter.org

Prevent Child Abuse America

Chicago, Illinois

312–663–3520

www.preventchildabuse.org
U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention

Washington, D.C. 20531

Official Business

Penalty for Private Use $300

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