Seven-year-old Isabella Abreu suffered a fall approximately three to four weeks before her death, after which she experienced progressive leg pain, swelling, inability to walk, decreased appetite, skin ulcerations, and petechiae (tiny red dots). Her mother, Viviana Roig-Caballero, did not seek medical treatment during this period, instead using home remedies such as Arnica cream, a knee brace, and leg elevation. On May 6, 2022—the child's birthday—the mother noticed abnormal breathing and eventually brought the child to Arnold Palmer Children's Hospital, where ER staff found the child pale with agonal breathing, severe swelling, a distended abdomen, blood from the mouth during compressions, a severely dilated rectum with blood, and other concerning findings. The child coded four times and was pronounced dead at 10:39 PM. The cause of death was ruled Congestive Heart Failure, Not Otherwise Specified, with the manner of death ruled Natural. The Child Protection Team concluded the death resulted from medical neglect by the mother, and she was arrested and charged with Aggravated Manslaughter of a Child.
Contexts/Conditions
Is there any mention of child drug ingestion or overdose?
Is there any mention of a drowning incident (either intentional or accidental)?
Is there any mention of a firearm incident?
Is there any mention of inappropriate supervision (e.g., child wandered off and drowned)?
Is there any mention of inflicted injury? (e.g. slapped, punched, kicked, choked)
Is there any mention of malnutrition, starvation, or dehydration?
Is there any mention of medical neglect?
The fatality report explicitly states: "CPT's conclusion was positive findings of medical neglect of the child as perpetrated by the mother." It also documents "Verified Findings of Death and Medical Neglect as to Isabella Abreu." The CPT doctor noted that "it is very likely the child would not have passed away if she had been brought for medical attention promptly after the family became aware of the child's lower extremity swelling, inability to walk, poor appetite and development of buttock and sacral skin ulcerations." The news article corroborates this, stating "medical treatment was not sought for a considerable length of time, unfortunately too late."
Is there any mention of a motor vehicle crash or incident?
Is there any mention of a murder-suicide incident?
Is there any mention of outdoor elements (including hot car deaths)?
Is there any mention of prenatal substance exposure (including fetal alcohol syndrome or neonatal abstinence syndrome)?
Is there any mention of sexual abuse?
Is there any specific mention of shaken baby or abusive head trauma?
Is there any mention of prolonged abuse or torture (including restraints, captivity)?
Is there any mention of an unsafe sleeping environment?
Individuals Involved
Was an adoptive parent or guardian involved in the death?
Was a biological father involved in the death?
Was a biological mother involved in the death?
The fatality report states the mother, Viviana Roig-Caballero, was found responsible for the child's medical neglect: "Verified Findings of Death and Medical Neglect as to Isabella Abreu, with Victoria Roig-Caballero as the caregiver responsible." (Note: the name 'Victoria' appears to be a typo for 'Viviana' in the report.) She was arrested and "charged with Aggravated Manslaughter of a Child." The mother delayed seeking medical care for weeks despite worsening symptoms, admitted she "was afraid she would be in trouble for not taking her sooner," and neither twin "had been to the doctor in at least two years."
Was a day care worker, babysitter, or nanny involved in the death?
Was a female paramour or friend involved in the death (e.g., girlfriend, stepmother)?
Was a foster parent involved in the death?
Was a male paramour or friend involved in the death (e.g., boyfriend, stepfather)?
Was another adult relative involved in the death? (e.g., grandfather, aunt)
Was a sibling involved in the death?
Child Characteristics
Was the child adopted?
Was the child homeschooled (including "cyberschooling") or taken out of school?
Was the child in foster care at the time of the incident?
Was the child living with relatives at the time of the incident (but not parents)?
Is there any mention of a neurological developmental child disability? (e.g., autism, intellectual disability, nonverbal)
Is there any mention of a physical child disability? (e.g., feeding tube)
Is there any mention of prematurity or low birthweight?
Is there a history of child protection reports prior to death (for this child or siblings)?
Does the child have a history of foster care (but not in care at time of incident)?
Is there a history of a sibling death (separate incident from this death)?
Parent/Caregiver Factors
Was an adult charged or arrested for the child's death?
The fatality report states: "On December 17, 2022, the mother was arrested and charged with Aggravated Manslaughter of a Child." The news article confirms: "Wednesday, officers determined that there was enough evidence to establish probable cause for aggravated manslaughter, and Friday, officers took Caballero into custody."
Is domestic violence by the parent/caregiver referenced?
Is there any mention that the death occurred in a temporary shelter or while homeless?
Is an intellectual disability of the parent/caregiver referenced?
Is the mental health of the parent/caregiver referenced?
Is a history of arrests or criminal charges for the parent/caregiver referenced?
Is substance use by the parent/caregiver referenced?
Notable Details
Several notable details warrant researcher attention. First, the Medical Examiner ruled the manner of death as "Natural" (Congestive Heart Failure, Not Otherwise Specified), yet the mother was still arrested and charged with Aggravated Manslaughter of a Child based on the CPT doctor's conclusion that the child "very likely" would have survived with prompt medical attention—a significant tension between the ME's ruling and criminal prosecution. Second, the child died on May 6, 2022—her own birthday (DOB 05/06/2014). Third, the fatality report notes that "a review of the mother's internet searches as well as photographs contained in her cellular telephone indicated that the child was ill for approximately one month prior to passing away," indicating that digital forensic evidence played a role. Fourth, the ER findings included deeply concerning physical findings—"The rectum was severely dilated with blood coming out, and scabbing was observed inferior to the left labia"—which were ultimately not attributed to sexual abuse per the investigation's conclusion of "No Indicators of Physical Injury and Sexual Abuse/Sexual Molestation." Fifth, the mother's name appears inconsistently in the fatality report as both "Viviana Roig-Caballero" (in the family composition chart and narrative) and "Victoria Roig-Caballero" (in the verified findings section), suggesting a clerical error.
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