Child Abuse The Forensic Investigation Michael Ward, MD Chief Medical Examiner Greenville, South Carolina Child Abuse • The physical, sexual, or mental injury, exploitation or negligent treatment of a child under the age of 18 years, by a person responsible for the child’s welfare. • Six patterns of abuse -Physical abuse -Sexual abuse -Intentional drugging -Medical neglect -Nutritional deprivation -Emotional abuse Child Abuse • In the United States, 1 – 2% of children reported to be abused. • Incidence is 700 to 1,200 per million. • 2,000 – 4,000 deaths per year. • Age-range: – One-third less than one year. – One-third 1 – 6 years – One-third 6 – 18 years Child Abuse • The Abuser – Parents (father more often than mother) – Other caregivers (boyfriends, babysitters) – Physically or emotionally exhausted – Alcohol or other drugs often involved Injuries in Child Abuse • Blunt injuries to any body surface most common injury. • Head injury most common fatal injury. • Blunt trauma to abdomen also common. • Skeletal injuries, burns, drownings are also seen. General characteristics of child abuse • Injury unexplained by the history given. • Delay in seeking care. • Changing, evolving, or inconsistent history. • Inappropriate affect of caregivers. • “Trigger event” precipitating loss of control of caregivers. Non-accidental Head Injuries • Formerly known as “Shaken Baby Syndrome” • Common findings include: – Subdural hemorrhage – Retinal hemorrhage – Diffuse axonal injury – May or may not have external injuries Non-accidental Head Injuries • The term Shaken Baby Syndrome has lost popularity in the United States and Great Britain. Many investigators disagree on the biomechanics of shaking infants, and many feel these injuries do not happen in this way. For this reason, many forensic pathologists have dropped the diagnosis of Shaken Baby Syndrome for the more general description of Non-accidental Head Injuries. Subdural Hemorrhages • Results from tearing of bridging veins extending from arachnoid to dura. • Hemorrhages are generally small and are markers of trauma. • Not a space occupying hemorrhage. • May be exceptionally small, or associated with focal sub-arachnoid hemorrhage. Subdural hemorrhage . Child Abuse The Forensic Investigation Michael Ward, MD Chief Medical Examiner Greenville, South Carolina Child Abuse • The physical,. exploitation or negligent treatment of a child under the age of 18 years, by a person responsible for the child s welfare. • Six patterns of abuse -Physical