Second Case Study

An eight-year-old boy was presented to the Alfred I. duPont Hospital for Children emergency department with a three day history of increasing abdominal pain. His father, a single parent, said he had been disciplining the boy and he accidentally fell onto a bed rail. The boy had obvious abdominal distention, linear bruises on his face, and loop marks on his buttocks and posterior thighs. Chest radiographs showed multiple healing rib fractures, and an abdominal CT scan showed an apparent abacus with a suspected small bowel injury.

He was taken to surgery and had repair of a mid-jejunal tear, and transferred postoperatively to the pediatric intensive care unit. His injuries were strongly suggestive of repeated acts of abuse, most likely at the hands of the father. The boy provided very little information to any of the physicians, nurses, or social workers, however, about what had happened to him.

During his postoperative recovery, while still attached to intravenous fluids, he was taken to the interview room in the CACD. The boy disclosed repeated episodes of physical punishment to the forensic interviewer, including being hit in the face, buttocks, and thighs with a cord and being punched and kicked repeatedly in the chest and abdomen. This history was what the physicians and hospital social workers expected based on his injuries. The ability of a skilled interviewer to obtain this history helped the medical team initiate earlier discharge planning, shortening his hospital stay.

The boy was discharged with a foster family through child protective services and had an uneventful recovery from his injuries. Faced with the child's videotaped statement and the physicians' documentation of the boy's injuries, his father plead guilty to causing the injuries in the manner in which the boy described.