What medical evidence needs to be preserved when physical abuse of a child is suspected?
If the child has died, there is no substitute for an autopsy. Specimen collection should include liver and bile. If the child survives, urine and serum specimens should be gathered, preferably when the child’s condition is at its worst. Some child injuries that appear to result from abuse actually result from undiagnosed inherited metabolic disorders. Geneticists call these “inborn errors of metabolism,” or IEM. Laboratory testing can discover IEM– if urine and serum are preserved for testing. They are rarely preserved, though, without lawyer intervention. If necessary, even a wet diaper may yield a sufficient specimen. Repeated unexplained injuries to a child incline physicians to diagnose child abuse. More than one SIDS death in a family affects them that way, too. Yet these recurrences also suggest a hereditary metabolic disorder. More information on IEM is available at www.mayo.edu/bgl.
