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