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National Institute of Justice Funds Research to Differentiate Injuries Caused by Child Abuse from Accidental Injuries

Child abuse is the leading cause of trauma-related deaths in children. In 2017, around 3.5 million children were referred to social services due to reports of abuse and neglect; 1,720 of them died. Over 70% of those who died were not yet 3 years old. Yet physicians may be missing cases of child abuse and reporting innocent parents because of a lack of research into the injuries children suffer during accidents and abuse.

Annually, about 2.8 million children are brought to emergency departments for fall-related injuries, according to Northwestern University professor of pediatrics and emergency room pediatrician Mary Clyde Pierce and University of Louisville bioengineering professor Gina Bertocci, who collaborate in studying the biomechanics of injuries in children.

“Although injuries from accidental falls in children are common,” according to Bertocci and Pierce. “History of a fall is the most commonly stated false scenario provided by caregivers to conceal physical abuse.”

When Pierce was a newly-minted pediatrician, a detective investigating the abuse of a baby boy asked her how much force it would take to cause the bone fracture observed in the baby. She did not know. She searched the medical literature to no avail. No one had investigated the question.

When she was working on another “ugly” case of child abuse, she turned to Bertocci with a question similar to what the detective had asked her. Seeking the answer to that question became the foundation of their joint research.

Supported in part by a series of grants from the National Institute of Justice dating as far back as 2008, the pair have jointly investigated bruising patterns in child abuse victims, metaphyseal lesions—a fracture commonly associated with infant abuse—and the biomechanics of short-distance falls in children. Currently, they are collaborating with mechanical engineers Angela Thompson and Raymond Dsouza of the iRAP Laboratory to develop an injury risk curve to predict the probability of head injuries in pediatric falls.

“Injury thresholds are largely based on scaled human adult thresholds and/or primate models,” the researchers wrote. “Using head injury thresholds that are scaled form adults or primates can lead to inaccurate conclusions regarding whether or not a fall can generate serious or fatal head injury in a child. Since biomechanical analysis is a critical component in cases involving a fall history, these inaccuracies may translate into failure to prosecute a guilty perpetrator or failure to acquit an innocent suspect.”

In one study, they outfitted children in daycare centers with instrumented headbands and observed their activities for months using video surveillance. They captured over 3,000 falls, about a third or which occurred on the playground, measuring the dynamics of the falls (forward, rearward, feet­ or head-first), and which body part impacted first. For head falls, the face impacted first 40% of the time. The key finding was that “across 3,256 falls, no children sustained moderate or severe injuries.”

They are also working on a digital 3-D model to predict bruising patterns because bruising is the earliest sign of physical abuse but is often overlooked by physicians. For instance, a bruise inside an ear may indicate a strike to the head. According to Pierce, “the most common thing that is misinterpreted prior to a child having a more serious injury, like a fracture or brain injury, is just bruising. We are used to bruises not being serious, so if you have an ear bruise and a fracture, nobody notices the ear bruise. But it is a tell-tale sign. That is the actual difference between an accidental injury and abuse.” 


Source: National Institute of Justice, Jim Dawson, “Child Abuse or Accident? Bringing Science to Pediatric Emergency Departments and Forensic Investigations,” February 8, 2021;

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