# Case report: A systematic approach for the forensic evaluation of child abuse: lessons from a complex case

## TL;DR

This paper presents a complex case of child abuse and neglect, emphasizing the importance of a systematic forensic evaluation to distinguish intentional injury from accidental ones.

## Contribution

The paper provides a detailed case study illustrating the application of international protocols in diagnosing child abuse amidst complex medical conditions.

## Key findings

- A systematic diagnostic work-up led to a definitive diagnosis of child abuse and neglect.
- The case highlights the challenges of evaluating abuse in children with underlying medical conditions.
- The approach serves as an educational resource for healthcare professionals.

## Abstract

Child abuse (CA) remains a significant public health concern, where distinguishing between accidental and intentional injury is particularly difficult in complex cases involving underlying medical conditions. We present a disturbing case study of severe abuse and neglect to illustrate the necessity of a systematic and evidence-based approach to forensic evaluation. The case featured a complex clinical picture: multiple bone fractures in a child with Infantile Epileptic Spasms Syndrome (West Syndrome), under treatment with valproic acid, and evidence of cocaine exposure. A systematic diagnostic work-up, structured according to authoritative international protocols, was conducted, including detailed medical history, physical examination, imaging, toxicological, and genetic analyses. Despite these compounding challenges, a careful clinical evaluation and critical review of international guidelines led to a definitive diagnosis of child abuse and neglect. This work represents a valuable educational resource for healthcare professionals and underscores the significance of implementing systematic protocols for assessing child maltreatment.