Child abuse: Difference between revisions
(Created page with "==Background== *Infant and children with disabilities are at higher risk *In >80% of cases, the parent or primary guardian is the abuser *Risk factors **Domestic violence **Ma...") |
(Additions to workup) |
||
Line 31: | Line 31: | ||
==Workup== | ==Workup== | ||
*Skeletal survey for all children < 2 years of age | |||
##Skull AP and lateral view | |||
##Chest AP and lateral view | |||
##Right and left oblique of the chest | |||
##AP of the abdomen to include pelvis and hips | |||
##Lateral spine to include cervical, thoracic, and lumbar vertebrae | |||
##AP bilateral humerus | |||
##AP bilateral forearms | |||
##AP bilateral femurs | |||
##AP bilateral tibia and fibula | |||
##Posterior view of the hands | |||
##Dorsoplantar view of the feet | |||
*Head CT for any child < 1 year with suspicion of abuse or >1 year with concerning signs of head trauma | |||
==Management== | ==Management== |
Revision as of 22:48, 14 June 2014
Background
- Infant and children with disabilities are at higher risk
- In >80% of cases, the parent or primary guardian is the abuser
- Risk factors
- Domestic violence
- Maternal depression
- Drug and alcohol abuse
- Premature birth
- Unrealistic expectations for the child
Clinical Features
- History given is inconsistent with the mechanism of injury
- Bruises, ecchymosis, and soft-tissue injuries on the face, cheeks, back, neck of if the child is not cruising yet
- Bruises in clusters or patterned marks
- Fractures highly suspicious of abuse:
- Rib fractures, especially posterior
- Metaphyseal or "bucket handle" fractures
- Scapular fractures
- Spinous process fractures
- Sternal fractures
- Fractures moderately suspicious of abuse:
- Long-bone transverse or spiral fracture of the diaphysis of the femur, humerus, tibia
- Multiple bilateral fractures
- Different stages of healing with multiple fractures
- Epiphyseal separations
- Vertebral body separation
- Complex skull fractures
- Pelvis fractures
Workup
- Skeletal survey for all children < 2 years of age
- Skull AP and lateral view
- Chest AP and lateral view
- Right and left oblique of the chest
- AP of the abdomen to include pelvis and hips
- Lateral spine to include cervical, thoracic, and lumbar vertebrae
- AP bilateral humerus
- AP bilateral forearms
- AP bilateral femurs
- AP bilateral tibia and fibula
- Posterior view of the hands
- Dorsoplantar view of the feet
- Head CT for any child < 1 year with suspicion of abuse or >1 year with concerning signs of head trauma