Child abuse: Difference between revisions
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*Bruises in clusters or patterned marks | *Bruises in clusters or patterned marks | ||
*Fractures highly suspicious of abuse: | *[[Fractures]] highly suspicious of abuse: | ||
**Rib fractures, especially posterior | **Rib fractures, especially posterior | ||
**Metaphyseal or "bucket handle" fractures | **Metaphyseal or "bucket handle" fractures | ||
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*Treat injuries as indicated | *Treat injuries as indicated | ||
*Report abuse to the appropriate state child protection authority | *Report abuse to the appropriate state child protection authority | ||
==Disposition== | ==Disposition== | ||
*Admit for medical treatment or if any question of child's safety upon discharge | *Admit for medical treatment or if any question of child's safety upon discharge | ||
==Source== | |||
[[Category:Peds]] |
Revision as of 00:47, 19 September 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
- AP and 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
- Treat injuries as indicated
- Report abuse to the appropriate state child protection authority
Disposition
- Admit for medical treatment or if any question of child's safety upon discharge