Skeletal evidence for child abuse: a physical anthropological perspective.

Analysis of the skeletal remains of abused children can prove challenging for forensic pathologists and radiographers who are inexperienced in the direct examination of bones. In such cases, radiographically invisible skeletal lesions that document a history of trauma can often be identified by a physical anthropologist with appropriate osteological experience. This is illustrated by cases in which skeletal remains of four murdered children and a mentally handicapped adult produced evidence of antemortem trauma and perimortem injuries that was critical in developing murder cases against the assailants. In these cases, well-healed areas of subperiosteal new bone formation were identified that were below the threshold of radiographic detection. Such injuries provide strong evidence for a history of physical abuse.