Child protective services (CPS) and law enforcement may become involved when a child presents for medical care with an unexplained injury; this occurs when there is concern for abuse or the history is insufficient, absent, or discordant with the claimed mechanism. The multidisciplinary team is responsible to interview those who were present during the reported event and evaluate and investigate contextual details. This includes assessing whether the implement supposedly used matches the injury pattern (as described in “Patterns of Injury” above).
Scene re-enactment is a key piece to diagnosing these injuries effectively and determining the validity of the initial history provided. Medical providers cannot go to a patient’s home to see more objectively what, where, and how it occurred. That is why an investigation is needed and multidisciplinary team engagement is paramount.
According to the US DOJ (https://www.ojp.gov/pdffiles/91190-6.pdf) “Reenactment of the Incident [--] Objectivity is without a doubt the most important quality you should possess as an investigator.”
“Reenacting the incident as given to you by the witness is a good way to obtain objective information and to answer any questions you may have. Using yourself or another adult, but never the child, you can reenact the incident at the scene, at your home or office, and, ultimately, in court as demonstrative evidence.”
“The fact that the time of exposure, temperature of the water, and degree of the burn are all related will test the accuracy of the caretaker’s reenactment of the incident.”
“When diagramming, be sure to include all items in the room where the incident occurred. Children often climb when they are exploring. You may think the sink is too high for access by the child, but a determined child may have climbed from a step stool, to the toilet seat, to a hamper, and then the sink.”
“Accurate measurements of the items involved in the incident— tub, basin, stove height, height to object, etc.—are essential. Photographs of these items should document the size and shape of the item and should contain a measure scale.”
IF YOU NEED A Child Abuse EXPERT, CALL MEDILEX AT (212) 234-1999.