Background and objective To improve the currently low conviction rate in cases of child abuse a forensic examination center for children and adolescents (FOKUS) was established in Vienna, Austria. Besides a state of the art treatment combined with forensic documentation, one of FOKUS’ key goals is to identify potential areas for improvements within the process legal proceedings in cases of child abuse through constant scientific monitoring. The accompanying study at hand includes all patients referred to FOKUS within a two year timeframe ( n  = 233), monitoring their progression from first contact with the medical professionals from FOKUS to the end of criminal proceedings. A detailed analysis of case files was performed in those cases that were reported to the legal authorities by the clinicians of FOKUS ( n  = 87). Aim of the study is to investigate which factors contribute to the initiation of legal proceedings and a successful conviction. Results Multivariate logistic regression analyses showed that main proceedings were opened more often in cases where the offender was an adult ( p  < 0.001) or admitted his guilt ( p  < 0.001) and if digital traces were available ( p  = 0.001) or trial support ( p  = 0.024) present. Furthermore, the combined occurrence of medical documentation and victim disclosure was related to a higher probability of opening main trials. Conclusion These findings underline how challenging the successful persecution of an offender in cases of child abuse is.