Child abuse
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