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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?
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:
Cutaneous (Skin) Injuries
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:
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:
Natural or Normal Bruising
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.
--Farley M.S., Robert Hugh, and Robert M. Reece M.D., "Recognizing When a Child’s Injury or Illness is Caused by Abuse", U.S. Department of Justice, 2002, http://www.ncjrs.gov/pdffiles1/ojjdp/160938.pdf
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- Coordinating Author/Instructor: Tracy Appleton, LCSW, MEd
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