Forensic expert’s role in pediatric emergency: Differentiating child abuse from accidental injuries; A case series

Abstract

Background: Child abuse remains a significant global concern, with alarming statistics reported annually. In 2022, the United States recorded 558,889 cases of child abuse, with neglect, physical abuse, and sexual abuse being the most common forms. In India, crimes against children increased by 8.7% between 2021 and 2022, with kidnapping and sexual offenses accounting for over 85% of the reported cases. Differentiating between accidental injuries and those resulting from abuse remains a major challenge in pediatric emergency care. Method: This report presents two clinical cases referred to forensic experts by pediatricians for evaluation. Case 1 involved a 7-month-old male infant with an abdominal firearm injury, initially suspected to be a homicidal attempt. Case 2 concerned a 4-year-old girl presenting with genital and abdominal injuries and a reported history of a fall; the case initially raised suspicion of sexual abuse. Both cases underwent detailed clinical examinations, forensic assessments, and reviews of investigative findings. Results: In Case 1, a circular firearm entry wound measuring 5 mm in diameter with an abraded collar was noted in the left hypochondriac region. Although the pellet could not be retrieved surgically, it was later recovered from the faeces and identified as a .22 calibre. Based on scene photographs, police investigation, and forensic evaluation, the injury was concluded to be accidental. In Case 2, examination revealed blunt trauma contusions on the labia majora and the right hypochondriac region along with minor abrasion on lower limbs. The labia minora and hymen were intact, and the injuries were found to be consistent with the reported history of a fall. Conclusions: These cases illustrate the complexity of distinguishing child abuse from accidental trauma. Early forensic involvement and a multidisciplinary approach are vital in ensuring accurate diagnosis and appropriate legal action. Structured protocols in tertiary care settings can support better outcomes in child protection and medico-legal reporting.