Rotorua baby Karlos Stephens was just learning to crawl when he was killed. His death is not the first and will not be the last.
The Bay of Plenty continues to grapple with a serious child abuse problem, ranking consistently as the worst or second-worst in the country over the past 10 years.
Reporter Caroline Fleming followed the case through trial and spoke to Bay of Plenty Police district co-ordinator of child protection Lindsay Pilbrow, who played a key role in securing the manslaughter conviction.
Baby Karlos Stephens' first teeth were starting to peek through when he died.
He was finally getting the hang of crawling and the kind-natured, quiet baby was taking his first dives into solid foods.
But one day in the last weekend of November 2014, the 10-month-old was killed at the hands of a man he adored. A man who made the young baby's face light up when he came into the room.
Last Friday, Shane Claude Roberts, 61, was found guilty of the manslaughter of baby Karlos.
The cheerful little boy had been taken to hospital with severe head trauma on the morning of November 30, 2014.
There were small blood pools on the surface of both sides of his brain and bleeding behind his eyes. But there was not a bruise or scratch on Karlos' body.
This sort of injury typically causes the brain to swell, putting a strain on the heart to pump blood to the head. Ultimately, the lack of blood and oxygen to Karlos' brain killed him.
It was ruled it was near impossible this sort of trauma could have been caused accidentally.
Medical experts compared the 10-month-old's injuries to those seen in car crash victims or infants who had fallen from more than a 2m height.
Throughout court proceedings, the Crown explored the idea Karlos could have been shaken, kicked and punched or even slammed or thrown.
It was unclear how long the baby survived after the injury. Experts speculated it was likely between five and six hours.
Either way, they agreed if Karlos had received medical attention immediately, he may well still be here today.
He left behind a twin brother, now approaching his 7th birthday.
The boys were born on January 17, 2014, six weeks premature, to Rotorua woman Pamela Stephens.
Stephens was living at her mother's Clayton Rd address with her other four sons at the time.
But before long, she began suffering what her doctor described as post-natal depression. She felt "helpless and hopeless" and was struggling to form a bond with her new baby boys.
Stephens began going out partying and drinking after her children had gone to bed. She turned to drugs, like methamphetamine, as a way to try and help her cope, she told the court during Roberts' trial.
Around this time she met Roberts, then in his mid-50s.
The two formed a bond, and Roberts told Stephens he and his ex-wife had raised twin girls and he could take on the care of the baby boys if needed.
A matter of weeks later, Stephens turned up on Roberts' doorstep on a rainy and windy night with the boys in blankets. She was taking him up on his offer.
Six months later, Roberts would kill one of her little boys.
It took police four years to arrest Roberts after medical evidence proved the baby had died from a traumatic head injury, not a sudden illness as first suspected.
Detective Senior Sergeant Lindsay Pilbrow, Bay of Plenty Police district co-ordinator of child protection, was a key player in championing the arrest of Roberts as an ongoing police probe into the case found startling evidence.
At a round table at the Rotorua Police Station, days after the trial wrapped, he told the Rotorua Daily Post Weekend the initial investigation team had been "uneasy" from the beginning about what had happened to baby Karlos.
It is the same round table the city's child protection agencies meet at to discuss and address the danger children in the region face in their own homes daily.
"We have a relatively high amount of child abuse and protection cases in the Bay of Plenty - up there in the top few in the country for repeat victimisations."
Pilbrow said his team was consistently busy.
He could not provide child abuse statistics but figures provided to the Rotorua Daily Post Weekend by Oranga Tamariki show that between 2010 and 2019, there were 24,701 findings of child abuse in the Bay of Plenty region.
These included physical, sexual and emotional abuse and neglect.
The Bay of Plenty ranked as the worst or second-worst in the country over the 10 years.
In the same period, Oranga Tamariki received 95,591 reports of concern from those concerned about the wellbeing of a child in the region.
Members of the public questioned why it took almost six years for Karlos to get justice but Pilbrow said it came down to securing international medical expertise on what exactly had caused his death.
The investigating officers needed to be certain, in their view, the baby had not died of natural causes.
The expert opinion was clear - the traumatic head injuries the 10-month-old suffered were not accidental.
So when the file landed on Pilbrow's desk in 2016, he had a case to pursue.
Pilbrow said the sooner you can get evidence, the better, but he did not believe the delay had any major effect on the results of Karlos' case.
Roberts' arrest was the result of a "team effort" and a "final push" in 2018.
Although Pilbrow was satisfied someone was being held accountable for Karlos' death - Roberts will be sentenced for manslaughter in February - he said despite the verdict "there are no winners in it".
The everlasting pain Karlos' death had caused so many was all part of the "tragedy".
Pilbrow has been with the police for 32 years and led the district's child protection unit for close to five of those.
The unit stretches from as far as Athenree, across to Ōpōtiki and down to Tūrangi.
He told the Rotorua Daily Post Weekend even right now, he was dealing with a handful of child homicide cases.
"It's not getting any better. Things need to change. We've got to stop hurting our kids and stop believing that it is okay."
More often than not, children were being hurt by people known to them. Those they trust.
But he said the onus did not just lie on offenders but every person around them and the community itself.
Poverty, unemployment and "a whole raft of things" add to the pressure in some homes and lead to violence and abuse.
But a number of agencies, teams and programmes in the community are working to make a difference to the city's most vulnerable.
Dedicated child protection teams working alongside agencies such as Oranga Tamariki and Tipu Ora, stronger connections with local hospitals and social workers and even specialist doctors employed to solely deal with abuse-type medical examinations were all preventative actions being taken in the community, he said.
"We just want to make sure these kids don't get hurt and that they are safe."
He said there were good parents and good families in the community but some just needed some help.
He said they aimed to get offenders restorative help and only wanted to get the courts involved if they had no other choice.
Every day, he was seeing abuse of children coming from below-average lifestyles.
Kids were not going to school or being fed and the problem often escalated from there, he said. It was at that point agencies wanted to get involved and provide wrap-around care.
One particular case, the murder of 2-year-old Nevaeh Ager in Maketū, he said was truly "horrible" and "so tough" on his staff.
He said he saw photographs that he "wish he hadn't" and they had worked hard to provide support for the team that worked on that case.
Whether it be mandatory workshops or mental health assistance, he said downtime in a job like this was vital.
"We've really got to keep a close eye on people."
Some homes were filled with violence but it was important that children knew what was happening was not okay and police were there to "listen and help", he said.
Every child abuse case, although tragic, offered a new piece of learning for police, which he said was vital in saving the lives of many others.
He said he wished he could say there would be no more baby deaths in the region, but that would not be true.
"I genuinely hope we can see less child abuse, but it will require some changes."
He said "small steps" were taking place every single day to make a safer place for the community's children and he would continue to work hard for those most vulnerable.
At the end of the workday, Pilbrow goes home to children of his own.
He said sometimes it was difficult if he was working on a case that involved children the same ages as his own.
"You really do have to pinch yourself sometimes."
When asked why he was so passionate about child protection and chose to lead a strong team of investigators in the field, he said he felt it was important to "deal with the most vulnerable" in the community.
More often than not, children involved in abuse came from vulnerable backgrounds and the difference for them was that no one stepped up and made a change, he said.
"No one was speaking for baby Karlos."
'For every child abused - six adults know it's happening'
From Merepeka Raukawa-Tait's experience, child abuse has "always been with us" as a city and the country's history in this area is "shocking".
"I believe society has learned to live with it. It will get worse."
Raukawa-Tait is the former chief executive of New Zealand's Women's Refuge organisation, the Whānau Ora Commissioning Agency chairwoman and is a Lakes District Health Board member and a Rotorua district councillor.
She told the Rotorua Daily Post Weekend most cases of child abuse go unreported and "for every child abused, six adults know it's happening".
Families had a lot going on in their lives but it was important to watch out for those under pressure to spot the signs early, she said.
"Children are often on the receiving end of built-up pressure, so try to help reduce that and let parents know that you will not stand by and see a child hurt."
She said speaking up, getting family members onside, and reporting suspicions were important.
Do you need help?
If you're in danger now:
• Phone the police on 111 or ask neighbours of friends to ring for you.
• Run outside and head for where there are other people.
• Scream for help so that your neighbours can hear you.
• Take the children with you.
• Don't stop to get anything else.
• If you are being abused, remember it's not your fault. Violence is never okay
Where to go for help or more information:
• Shine, free national helpline 9am- 11pm every day - 0508 744 633 www.2shine.org.nz
• Women's Refuge: Free national crisis line operates 24/7 - 0800 refuge or 0800 733 843 www.womensrefuge.org.nz
• Shakti: Providing specialist cultural services for African, Asian and middle eastern women and their children. Crisis line 24/7 0800 742 584
• It's Not Ok: Information line 0800 456 450 www.areyouok.org.nz