The diagnosis of child abuse is based on the child's history, physical findings, and when appropriate, laboratory and evidentiary tests. This diagnosis is often complicated and depends on factors in addition to the medical evaluation. Formulating a conclusion and reaching a diagnosis of child abuse may require the assistance of a pediatric child abuse expert. The final determination of the crime of child abuse is ultimately a legal matter to be decided by the courts.
The suspicion of abuse is not the same as the diagnosis of abuse. Your suspicion, based on sufficient evidence, leads to a report to the State Central Register. This report results in further investigation by Child Protective Services and law enforcement. You should be ready to render opinions with regard to the significance, if any, of the medical findings and the likelihood the injury was inflicted. Although the burden of proof of who perpetrated the abuse lies with the investigators, the determination of the cause or possible causes of the injury is often critical to the legal case.