Child Abuse and Its Mimics in Skin and Bone

By B.G. Brogdon, Tor Shwayder, and Jamie Elifritz
CRC Press (2013)

Challenging the state’s scientific evidence can be a daunting task, especially in child injury cases in which oftentimes the only evidence against a defendant is a questionable judgment call made by one medical professional or cryptic medical records. It is becoming standard practice to enlist the help of independent forensic pediatricians and pathologists to interpret the complicated evidence in these types of cases. Child Abuse and Its Mimics in Skin and Bone is a book that outlines bone and skin conditions that mimic and could be mistaken for actual physical abuse in children. The book was written by medical doctors with collective expertise in forensic radiology, pediatrics, and dermatology. Its stated design is for anyone who is confronted with the task of sorting out abuse from nonabuse in child injury cases, but the technical language of the book does make some of its content a real challenge for nonclinicians. This book is not designed as a quick read on the subject of defending child injury cases, but rather is more of a text reference that could be called upon as a resource when a specific skin or bone injury arises.

The book has a user friendly layout organized into five chapters over 193 pages. Chapter 1 serves as an introduction to the subject and provides a historical perspective of the concept of child abuse. It also mentions what constitutes an acceptable radiologic and dermatologic survey in infants and young children, which an attorney might find useful when evaluating any similar exams performed by the state’s witnesses.

Chapters 2 and 3 cover musculoskeletal trauma and how they appear in radiologic evidence. This is the “bone” injury section of the book, and readers will find approximately 50 different picture-rich examples of intentionally inflicted bone injuries and their many nonabuse-related mimics. The photos provided here appear to be almost entirely X-ray photographs. In these chapters the authors provide highly technical observations about X-ray photography in abuse cases contrasted against X-ray photography in nonabuse mimic cases. The faint of heart beware, these two chapters are highly technical and require a medical dictionary for the lawyer to comprehend. Chapter 3 lists dozens of potential mimics found in bone. Some examples of the many mimickers detailed are Little Leaguer’s Shoulder, birth injuries, rickets, Vitamin A intoxication, and osteogenesis imperfecta.

Chapters 4 and 5 of the book deal with skin injuries. Over the course of these approximately 50 pages the reader gains insight into dozens of skin conditions that could easily be mistaken for child abuse. This section of the book is much less technical and much more digestible for the nonclinician. The chapters include many color photographs that illustrate the authors’ observations of skin injury quite well. The subjects covered include mimics of bruises, pattern injuries, and burns. Upon reviewing these two chapters and their graphic photographs, an attorney would have a usable insight on how to account for unexplained skin injuries.

Overall, while there are plenty of usable nuggets of information that could be grabbed by an attorney looking for a general read in the subject, this book is highly technical and should best serve as a technical desk reference for analyzing evidence in cases with specific injuries such as burns, rib fractures, or skull fractures. This text would be best understood by clinicians in the field. But in the skilled hands of the attorney willing to put in the effort to comprehend the medical language, the information contained within this text will hopefully fulfill the authors’ intentions of (1) helping those charged with the task of distinguishing between actual abuse and nonabuse in children get it right and (2) eliminating the horrors that go along with getting it wrong.

About the Reviewer

Brandon Sanchez has been a trial attorney with the Missouri State Public Defender System since 2003. He has litigated numerous child injury cases.

The opinions expressed in reviews are those of the reviewers and do not necessarily reflect the opinion of NACDL.

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