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When straddle injuries are confused with child abuse

Medical office - middle-aged male doctor greeting patient, shaking hands.

By: Gregg R. Woodnick and Isabel Ranney

Imagine you are the mother of a six-year-old girl. After a day of playing at the park, you are getting your child ready for a bath when you notice blood in her underwear. Upon further investigation, you see that your child is bleeding from her vaginal area, which also appears bruised. Understandably panicked and concerned, you rush your child to Banner Urgent Care, where the doctor comments that he suspects your child to be a victim of child abuse.

Injuries with these symptoms are called straddle injuries. Straddle injuries occur when a female hits her vulva or perineum (external female genitalia) on an object, and the force of her weight on the object causes injury [1]. Signs of a straddle injury include tears in the vaginal area, lacerations to the urethra and hymen, and minor bruising and swelling. Straddle injuries often happen when children are playing on a playground or engaged in a sport-related activity. For example, in most cases, a young girl is injured when she slips off a bicycle seat and straddles the frame or falls while climbing over playground equipment.

Straddle injuries are the most common type of unintentional injury to the genitalia in females [2]. Of the pediatric genitalia trauma cases that end up in the emergency room, straddle injuries make up 81.9% of the injuries [3]. Most of these injuries result from accidental trauma, and only 4-9% of cases require surgery [4]. Although most straddle injuries are benign, the child may present with significant trauma to her vaginal area that appears physically consistent with injuries caused by sexual abuse. Physicians often notate that the child suffered from “suspected non-accidental trauma” (SNAT), which is medical parlance for suspicion of child abuse.

When doctors—who are all mandatory reporters—note their suspicions, the hospital contacts the police and the Department of Child Safety (DCS). (Some hospitals also have internal response teams for cases of suspected child abuse, which usually include social workers, a law enforcement liaison, and forensic medical providers such as nurse examiners, pediatric radiologists, etc.). DCS sends investigators to interview the parents separately and, if possible, the child. If the parents did not witness the incident, they may provide alternative explanations for how the injury could have occurred – perhaps she slipped in the bathtub or sat on her bike at an odd angle [5]. The investigators will also ask for a detailed history of the daughters’ life, including if she plays any sports, goes horseback riding, etc. Although parents are presumed innocent in the courtroom, the parents accused of abuse at the hospital bear the burden of explaining why their child’s injuries appear non-accidental. If the treatment provider or response team already believe the child has been abused, this can be a tall task for parents.

Suppose the explanations and oral history appear incomplete. In that case, investigators may view the parents’ stories as inconsistent and suspicious. Combined with the nature of the injury, DCS and law enforcement may conclude there was wrongdoing. Additionally, if the investigators interview the child, she may be unable to articulate how she was injured. Moreover, even if the parents describe events consistently with one another, the investigators may conclude that they collaborated to falsify events and are not being truthful despite saying the same things.

Although parents are not required to testify in dependency and severance matters, Arizona courts can use the parent’s decision not to testify against them. Unlike in criminal matters, in which the Fifth Amendment protects the defendant from being forced to testify, the dependency judge will assume that a parent who does not testify is hiding something important. Even with multiple expert witnesses testifying for the defense, the court expects to hear the parent’s explanation and may decide the case just based on the parent’s refusal to do so. The decision whether to testify is critically important.

Of course, doctors are mandatory reporters, and it is absolutely proper for the provider to contact law enforcement if they believe a child has been abused. The mandatory reporting statute, A.R.S. § 13-3620, requires physicians, physician assistants, nurses, teachers, and others to report suspected abuse, and there may be professional or criminal consequences for failing to report. DCS may remove the children from the parents if they think that the child’s injury was due to sexual abuse.

Although the burden of proof is on the State in the subsequent dependency and criminal matters, parents must attempt to affirmatively prove their innocence in most cases. Often, parents and their attorneys must persuade and educate the court that what was perceived as child abuse is nothing more than an accidental injury. This may mean finding the right medical expert to review the medical records and engaging a biomechanical expert to testify about the physics of straddle injuries and ways to determine forensically whether the type, severity, or location of the injury is consistent with abuse. Not every expert in these fields will agree with the findings of a particular case, which sometimes requires involving multiple experts to give a spectrum of opinions to discern what occurred.

Legally, the right to direct your child’s upbringing is a fundamental liberty interest entitled to high deference, but it does not protect itself. Understanding your rights is a good starting point, but as this “straddle injury” scenario makes clear, there are innumerable choices that impact your parent-child relationship when an accident turns into an abuse allegation.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589640/
[3] https://link.springer.com/article/10.1007/s00383-020-04736-7
[4] https://oce-ovid-com.ezproxy1.lib.asu.edu/article/00006565-201106000-00020/PDF

Gregg Woodnick is the managing attorney at Woodnick Law, PLLC in Phoenix. The firm frequently provides advocacy for parents and caregivers accused of child abuse and neglect throughout Arizona. 

Isabel Ranney is currently working at Woodnick Law as a law clerk and is in her second year of law school at Sandra Day O’Connor College of Law at Arizona State University.

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