Child Abuse Investigations: Follow the Evidence

How can we tell whether a child died from co-sleeping or if she was smothered

intentionally by a parent who had tired of her crying? How can we tell if the story parents

gave about a broken leg or a brain bleed is plausible? We lean on child abuse specialist

pediatricians, especially in physical abuse cases, to help us solve these and other

quandaries. These skilled physicians are invaluable members of the multidisciplinary

team (MDT). I consult with our local specialists on many cases, and they often clarify

baffling injury patterns.

Collecting evidence during an investigation.

Recently, I delivered a four-hour Child Abuse Investigations training session to around 200 law enforcement officers at a state investigative training conference. We went through a physical abuse and a

I conducted a case study on physical abuse from a nearby jurisdiction. This was the first time I had revisited the grim details of this physical abuse case I was consulting on, and it reminded me how painfully it concluded. Here’s a synopsis of that case: A mother took her toddler to the emergency room (ER) because their leg was swollen, and they could not walk on it. X-rays revealed that the toddler had a displaced left femur fracture. While at the ER, a forensic nurse observed extensive burn scarring on both of the child’s legs. The mother attributed the broken leg to the victim falling off a changing table and explained the scarring by stating that several months earlier, the toddler had turned on the hot water while in the bathtub.

The doctor who consulted on this case thoughtfully deconstructed the mother’s

explanations, declaring them “total BS.” The doctor explained that if toddlers could

snap their femurs by falling off short tables, humankind would have never walked on two

legs. Once possible medical causes, such as an unlucky genetic propensity for brittle

bones, were ruled out, the doctor confidently opined that the baby’s broken leg was an

abusive injury. She even demonstrated the most common mechanism for this specific

type of break. Using a doll, she showed me that if a caregiver lifted the toddler’s ankles during a diaper change while simultaneously and violently pushing down on the upper legs, the femur would break in the pattern seen on this toddler.

Regarding the burns, the doctor stated unequivocally that the scars were not a

result of the toddler turning on the water in the tub. Instead, the doctor believed they were

inflicted during several different incidents involving unknown hot objects and water that

was poured, not splashed. She qualified her conclusions by noting it was difficult to be

certain since the injuries were scars rather than freshly burned skin.

So, what now? I believe most abuse specialists would agree that their conclusions are not infallible, nor a substitute for a thorough investigation. Yet, in my experience, investigators often run dry of curiosity if a “ruling” is provided by a specialist. The investigative risk here, of course, is confirmation bias. Once an expert shares their opinion, we tend to overlook any evidence that contradicts it. A specialist's input should guide our search, not conclude the investigation. In this case, I needed to look around the home for objects that could have caused the burns and ask the mother to demonstrate how she changed her baby’s diaper, particularly when they were squirmy and fussy. During the search warrant on the house, I used a thermometer to test the water temperature coming from the bathtub faucet and timed how long it took to reach its hottest temperature. I also tested the torque on the faucet handle with a wrench and a scale, and I measured the distance from the handle to the tub floor. I did all of this to determine whether a toddler could plausibly turn on the water by themselves, and if they did, whether the water was hot enough to inflict the severe burns that scarred their legs. My discomfiting conclusion at the end of these information-gathering exercises (my 200 new friends at the conference rightfully teased me for the rest of the day) was that the water was hot enough—150 degrees Fahrenheit—to severely burn the victim within a few seconds and that the low faucet handle needed so little effort to turn that the child could have easily reached it and turned it themselves.

Admittedly, my intention in conducting those exercises was to gather evidence

to disprove the mother’s story and support the doctor's findings. However, I had to

concede that the evidence I found, in some respects, corroborated the mother’s

account. Still, I faced the specialist’s assertion that the burn scar patterns suggested a

different source for the injuries. I spent hours examining photographs of the baby’s

scarred legs, comparing their shapes to various hair and clothing irons, as well as other

potential tools of torment, but I found nothing that matched.

The most harrowing find during the search of this house, the search of any

house was a shrine to a dead baby and a wooden box with his ashes. Later, I looked

up the case and read that two years before, this mother reported finding her infant face

down and dead. The cause of death was “undetermined,” and accidental

Causes could not be ruled out, so the case was closed.

This case reinforced that our role as investigators is to be independent fact

finders, not advocates for a particular outcome. I believe this mother had a hand in the death of one of her babies and is possibly torturing another, but the investigative facts I could find did not fully support that conclusion. Ultimately, she was charged with enhanced child endangerment for leaving the toddler in the bathtub while her water heater was cranked to its scalding maximum and with aggravated battery for breaking his leg during a diaper change (she never admitted to doing this, but there was sufficient evidence to prove she did). She pleaded guilty and was sentenced to probation. The children were taken to a safer home.

I remember feeling frustration and sadness over what I perceived as the

inadequacy of the punishment this mother received, and I continue to feel that way.

However, in hindsight, I can’t think of anything I would do differently. It wasn’t a perfect

investigation (there’s no such thing), but I did not let my belief about what the mother did

blind me to new information or distort the information I already had. This case reminds

me that our investigative role is about fact-finding and corroboration, not confirmation of what we believe. I can’t help but feel for victims or care about outcomes. I’m certain that’s true for most investigators, but as part of the criminal justice system in a free society, we must function above our own opinions. If we step outside our role, the risk of a false convictions or another kind of injustice greatly increases. That’s also why relevant, high-quality training on child abuse investigations matters so much. These are some of the most emotionally charged, complex cases we face—and they test everything we know about objectivity, empathy, and investigative skill. Training that reflects real-world challenges and equips us to handle them with care isn’t just professional development—it’s a safeguard against error, a support for victims, and a check on ourselves.