Intrafamilial abuse of minors in Marseille: an epidemiological study and forensic approach

Intrafamilial violence against children is a significant public health issue with long-lasting medical, psychological, and legal consequences. Forensic physicians play a critical role in documenting such abuse, yet their contributions are often overlooked.

Describe the characteristics of forensic medical evaluations performed on child victims of suspected intrafamilial abuse and assess the scope of the forensic physician's role.

This retrospective observational study was conducted at the Forensic Medical Unit (UMJ) of La Timone Hospital in Marseille. All medico-legal reports for minors (under 18 years old) who were referred for suspected intrafamilial violence between January 2020 and May 2022 were reviewed. Cases involving accidental or extrafamilial violence were excluded.

Among the 15,569 individuals examined at the Forensic Unit, 1008 forensic certificates involved minors in cases of intrafamilial abuse: 423 boys and 585 girls aged from 6 days to 17 years. Physical abuse was reported by 78% of children: 61% had at least one injury upon physical examination (mainly bruising), and more than a quarter of these injuries were identified as non-accidental. Psychological abuse was reported by 16% of children and was associated with physical abuse in 94% of cases. Significant psychological distress was observed in 16%, primarily among those over 12 years old. Neglect, mainly physical neglect, was reported in 19% of minors.

The study underscores the recurrent and complex nature of intrafamilial abuse and highlights the unique yet constrained role of forensic physicians. Enhancing multidisciplinary collaboration, such as through specialized pediatric forensic units (UAPED), is crucial for improving the assessment and documentation of all dimensions of child abuse.