Cpl. Craig Smith
Royal Canadian Mounted Police, Edmonton Major Crimes

The following is a typical scenario for a uniform or a plainclothes police officer who is expected to deal with all kinds of child abuse cases.

You receive a call from your supervisor, who tells you that Mrs. Johnson, the wife of a prominent local lawyer, has just brought her two-month-old son into the hospital. The child is unconscious and in critical condition. The pediatrician at the hospital believes the child may have been abused and has notified the police.

When you take a statement from the doctor, he tells you, "This child has a severely distended fontanelle and we are currently monitoring his ICP. The CT scan and MRI revealed that he has an acute on chronic subdural hematoma. The ophthalmologist has done a fundoscopic examination of the boy and found bilateral retinal hemorrhages. These findings are pathognomonic of a non-accidental injury. The next few days will tell the tale but in these cases a child will often die, not from the hematoma, but from the cerebral edema." Well, that's certainly refreshing isn't it?

Meanwhile, Mrs. Johnson has contacted her husband who has been away at a legal conference and is now on his way home. He will arrive tomorrow, so if you want to get a statement from Mrs. Johnson without her lawyer/husband hovering over every question, you better act fast! But how? What questions do you ask? How do you ask them? Do you accuse Mrs. Johnson of abusing her son? What do you do about the Johnson's other child - a 3-year-old daughter? Is she in any danger, and if so, what can you do about it?

From what the doctor has said, many police officers would not fully understand what is wrong with this little boy, let alone know how, or when, he was injured. Many of us would look at the doctor's initial statement and realize that the only "big word" we recognize is non-accidental.

When conducting a child abuse investigation it is essential that you have a basic understanding of shaken baby syndrome and the medical terminology commonly used to describe the injuries. The intent of this document is not to make police officers or child welfare workers into doctors, but to help investigators understand the meaning of frequently used medical terms, and enable them to conduct a proper investigation of a shaken baby incident.

What is shaken baby syndrome? Can "rough play" with a small child cause SBS? Can attempts at resuscitation (CPR) cause some of the injuries associated with SBS? The forces exerted in SBS cases are violent acceleration/deceleration forces. These are not casual injuries, caused by strenuous play.

Gentle shaking to waken a child or CPR does not cause retinal hemorrhages, subdural hematomas or cerebral edema, though offenders will often say they only shook the baby to try to help him regain consciousness after a short accidental fall. This is a common excuse. The generally accepted definition of shaken baby syndrome is: "Those observing the events felt the episode of shaking was so violent that the child would have to have been physically injured."

In SBS cases the most common reason for shaking, is a frustrated attempt by an adult to make the child stop crying. Unfortunately, this is an effective and deadly short term solution. Some children may in fact stop crying after being shaken, but this is due to sustained brain injury.

Babies are especially vulnerable to the lethal effects of shaking for two reasons:

1. Their neck muscles have not become fully developed and they have less control over the movement of their head.
2. Whereas an adult's head accounts for approximately 10 percent of their body weight, a baby's head is disproportionately large and accounts for about 25 percent of body weight.

All children who are shaken do not necessarily sustain detectible, physical injury, however, shaking can have irreversible and even fatal effects. If the child does not die, the results can still be horrific. SBS survivors sustain injuries ranging from "minor" brain damage, blindness, partial and full paralysis to being left in a permanent vegetative state.

Despite tremendous advances in medical science, there is still no way to regenerate brain cells and the effects of most of these injuries are irreversible.

Police officers don't like child abuse cases. The medical evidence can be confusing, there are usually no witnesses and it is hard to accept that a loving caregiver may be an abuser. In these cases, the police must often work closely with other professionals; social workers and doctors. Each has a complimentary role to play if they are to be effective in learning not only how a child was injured, but also who actually inflicted the injuries.

Investigative Guideline

This guideline should be followed if possible and practical. Each case is unique and there may be cases where these procedures are impractical or may jeopardize the safety of the child or investigation. In those situations the investigator must rely on their own best judgement and proceed as they see fit. In most cases however, the following step-by-step procedures will be most effective.

STEP ONE: INTERVIEW THE DOCTORS
Is the child dead or likely to die? What are the exact injuries? What caused these injuries? Take a full statement from the physician handling the case as soon as possible. Have them describe the injuries, their probable cause, and the prognosis for the child. If you don't understand a term - ask the doctor to explain it. If you don't understand it, a prosecutor probably won't understand it either.

When interviewing the doctor, make it clear that they can't accuse or interrogate anyone about the injuries. If they suspect that someone has deliberately injured a child it is not their place to confront them. That is the job of the police. An accusatory, confrontational doctor will, at the very least, alert a suspect to the possibility of an investigation and, at worst, cause them to flee, or shut down when interviewed by police. Promise the physician you will never try to perform an operation if they promise never to conduct an interrogation.

STEP TWO: INTERVIEW ANYONE WHO DEALT WITH THE CHILD OR THE CAREGIVERS
Who brought the child to the doctor or hospital? Was a parent, step-parent or babysitter present at the time of the injury? This information can often be obtained from the emergency room nurse, the attending EMT or the hospital social worker. If they have prepared a separate report for their own use, ask for a copy of the report to include in your file. However, this is no substitute for a proper statement.

What was the physical condition of the child when first seen? What was the attitude of the caregivers at that time - hysterical, angry, quiet? What did the caregivers say about the child's injury? Take a statement from these witnesses, because false explanations evolve and change over time as the suspect talks to more people and adapts the story to try to match the physical findings of the investigation.

STEP THREE: PHOTOGRAPH THE CHILD'S INJURIES
Have a medical photographer or an identification member record any bruises, abrasions or other injuries. Use a measurement scale to give perspective to the injury. Photograph the injuries daily to record the changes in color and clarity, as bruises may develop and become more distinct several days after the injury occurs.

STEP FOUR: INTERVIEW THE CAREGIVERS
This may be the most important interview conducted in the investigation. After gathering information about the nature of the injuries and who was with the child at the time of the injury, it is now time to interview the caregivers. This first interview should be non-confrontational. If you suspect that the child has been abused, you must give them the Police Caution (Miranda Rights), however, this should be done in a low-key manner. For example, "Mrs. Johnson, your son is seriously injured and the doctors are trying to determine exactly what happened. I need to talk to you, but I don't know what you are going to tell me. In this type of case there is the possibility that somebody may have deliberately hurt the child, so to be fair, I'm going to advise you of your rights before I talk to you."

It is my practice to advise suspects of their rights to counsel whenever the Police Caution is given, even if there is no intent to arrest or detain them. The procedure may differ in different jurisdictions.

As in so many interviews we are looking for the Five W's: Who, When, What, Where, & Why.

Stages of Step Four
A. I approach these interviews in an empathetic, non-accusatory manner expressing my condolences. For example, "I'm not going to say I know how you feel, because I've never experienced what you are going through. But I've talked to many people in the same situation that you are in right now. I wish there was something I could say that would take this all away, but I can't. All I can do is try to understand, from your perspective, what happened."

They may be angry and upset, but by treating them this way, it makes it difficult for them to lash out at you. You're also laying the foundations for a subsequent interrogation, so you want them to be comfortable with you. Let them talk and try not to direct them or interrupt. The first part of the statement should be in narrative form. Ask them to tell you everything that happened. If they don't know where to begin, pick a point about 12 hours before the incident in question. Then ask questions to clarify key points, using their terms.

B. Try to determine who had the opportunity to inflict the injuries. Note the names of everyone who had contact with the child around the time of the injury. Who first noticed the child's injuries and who took the child to a doctor? Was there any delay in bringing the child to medical care? Remember, an abuser will often delay taking the child to the doctor in the hope that they will recover. Try to establish if one person was alone with the child at the time of the injury.

C. Try to determine when the child was injured by asking when they were last behaving normally. Children with serious brain injuries show symptoms almost immediately. They may be lethargic, vomiting, and disoriented, or they may be rendered unconscious immediately after being injured. Try to determine the developmental level of the child. Could the child crawl, walk, or speak? What were this child's normal activities? Ask the caregiver when the child last ate, how much and what type of food, etc. When did the child last walk, crawl, speak, cry, or play? You are building a timeline to show that the child was behaving normally up until a specific event occurred.

D. Ascertain what caused the injury. Often, caregivers will give a poor explanation for the child's injuries. For example, "The child fell off the couch.� In a non-threatening manner ask where is the couch? What type of flooring is present? Has this ever happened before? Don't dispute their story, but ask them to help you by clarifying points about their explanation.

E. Obtain an explanation of where the injury occurred. If the child fell, determine the exact location and nature of the surface where they landed. If the child fell on a cement patio, you should see abrasions on the hands and knees. If these are not present, this will be an important factor in refuting the false explanation.

F. Ask the caregivers to sign a Medical Release of Information on this child and any other children in their care. You can truthfully tell them that this is a standard procedure in these cases in order to ensure the safety of the children.

F. After obtaining a statement, ask them to clarify some points by demonstrating what took place during a scene re-enactment. Videotape the re-enactment.

STEP FIVE: SCENE EXAMINATION
If the caregivers are cooperative, examine the scene with their consent. If you are unable to gain their cooperation, obtain a general warrant or a search warrant to conduct a full scene examination. Do you have the necessary grounds for a warrant? If you didn't have grounds to suspect them prior to taking a statement, do you now have sufficient grounds for a warrant?

The scene examination should be done as soon as possible, because things will change. The bloodstained wall and the empty liquor bottles, will probably have been cleaned up shortly after the injury, and you may lose important information about the physical surroundings as they existed at the time of the injury.

At the scene, take still photos, video footage and diagram measurements, noting the placement of any objects that may have played a part in the injury. For example, the presence of an undamaged wine glass on the coffee table next to the killer couch. Try to obtain a doll (a CPR resuscitation doll is best for this task) and recreate the fall that allegedly caused the child's injuries. Videotape this procedure to allow review at a later date.

STEP SIX: ENSURE THE SAFETY OF ANY OTHER CHILDREN
If the caregivers have other children, they should also be medically examined for signs of abuse. Abusers will often assault more than one child in a family. Work with social services who may need to protect other children at risk.

STEP SEVEN: GATHER BACKGROUND MATERIAL
Interview any other healthcare professionals who may have dealt with the caregivers. Take statements and determine if the story has evolved or changed over time. Check the medical records of this child to see if he or she was sick just before this last incident. Remember that frustration with a crying or sick child is often the precipitating factor in a shaking incident. Check the medical records of any other children in the home to determine if they have suffered similar injuries. You may need a search warrant to get this information if the caregivers have not given you a medical release of information. Interview former spouses to see if the caregivers have a past record of violence - especially toward children. Social services and police computer checks should be done, as well, to determine if there has been any past involvement with the caregivers. There may be a delay as you wait for the results of all of the medical tests and/or autopsy results.

STEP EIGHT: TEAM CONSULTATION
After gathering background information and speaking to medical experts who confirm that the child's injuries could not have resulted from the incident described, you should now facilitate a meeting between the prosecutor, the medical examiner, the social worker and key medical personnel.

It is essential that the prosecutor understands all the medical evidence. The opinions of all of the experts should be consistent as to the mechanism and timing of the injuries. If there is any doubt about the medical evidence, you may wish to consider obtaining a second opinion from a specialist in another area. It is vital that all the evidence is reviewed and understood by the police investigator, before he embarks on the next phase of the investigation.

STEP NINE: INTERROGATE THE SUSPECT
Arrest the suspect and interrogate. If you are armed with detailed background information and a positive attitude, you have an excellent chance of obtaining a confession. Listed to the right are some differences between an interview and an interrogation.

Cpl. Craig Smith has 26 years of experience with the Royal Canadian Mounted Police. In this position he has worked on many child physical and sexual abuse cases and homicides. He is also an expert consultant to the United States National Information, Support and Referral Service on Shaken Baby Syndrome.