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| ==Background==
| | #REDIRECT[[Nonaccidental trauma]] |
| *Infant and children with disabilities are at higher risk
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| *In >80% of cases, the parent or primary guardian is the abuser
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| *Risk factors
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| **Domestic violence
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| **Maternal depression
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| **Drug and alcohol abuse
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| **Premature birth
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| **Unrealistic expectations for the child
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| ==Clinical Features==
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| *History given is inconsistent with the mechanism of injury
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| *Bruises, ecchymosis, and soft-tissue injuries on the face, cheeks, back, neck of if the child is not cruising yet
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| *Bruises in clusters or patterned marks
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| *[[Fractures]] highly suspicious of abuse:
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| **Rib fractures, especially posterior
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| **Metaphyseal or "bucket handle" fractures
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| **Scapular fractures
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| **Spinous process fractures
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| **Sternal fractures
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| *Fractures moderately suspicious of abuse:
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| **Long-bone transverse or spiral fracture of the diaphysis of the femur, humerus, tibia
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| **Multiple bilateral fractures
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| **Different stages of healing with multiple fractures
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| **Epiphyseal separations
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| **Vertebral body separation
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| **Complex skull fractures
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| **Pelvis fractures
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| *Head Trauma
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| **Shaken Baby Syndrome - Retinal Hemorrhages
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| ***Present in up to 75% of cases and are virtually pathognomonic
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| ***Described as “dot and blot” hemorrhages or flame or splinter hemorrhages
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| ==Workup==
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| #Skeletal survey for all children < 2 years of age
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| ##Skull AP and lateral view
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| ##Chest AP and lateral view
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| ##Right and left oblique of the chest
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| ##AP of the abdomen to include pelvis and hips
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| ##AP and lateral spine to include cervical, thoracic, and lumbar vertebrae
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| ##AP bilateral humerus
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| ##AP bilateral forearms
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| ##AP bilateral femurs
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| ##AP bilateral tibia and fibula
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| ##Posterior view of the hands
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| ##Dorsoplantar view of the feet
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| #Head CT for any child < 1 year with suspicion of abuse or >1 year with concerning signs of head trauma
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| #Consider osteogenesis imperfecta with incidence of 1:20,000 and can present at any age due to a wide spectrum of severity
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| ==Management==
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| *Treat injuries as indicated
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| *Report abuse to the appropriate state child protection authority
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| ==Disposition==
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| *Admit for medical treatment or if any question of child's safety upon discharge
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| ==Source==
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| [[Category:Peds]]
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