Child Abuse

Abstract

Child abuse is a significant problem in the United States, with 905,000 children determined to be victims of abuse or neglect in 2006. More than 15% of these children were victims of physical abuse and almost 10% suffered sexual abuse. The consequence of missed cases of abuse is significant, with 25% of these children suffering more severe subsequent injuries before an appropriate diagnosis is made. In 2006 there were more than 1,500 deaths resulting from child abuse, making it the leading cause of death for children between 6 and 12 months of age. It is crucial that all health care providers properly identify and evaluate cases of child abuse. In addition, it is mandated by law that physicians report all suspected cases of suspected child abuse.

Appendices

Summary Points

Non-accidental trauma is still a leading cause of injury and death for children.

Health care professionals are ethically and legally obligated to notify the proper authorities whenever there is a suspicion of non-accidental injury of a child.

There are specific patterns of injury that suggest the likelihood of a non-accidental injury and pediatricians, ­emergency room physicians, and pediatric surgeons should be aware of the more common signs.

Editor’s Comments

It is sometimes difficult to maintain equanimity when faced with the responsibility of caring for a child who has been intentionally harmed, especially for those of us who care for children on a daily basis. It is an unfortunate fact of life, and our emotions cannot interfere with our duty to help the child. In most tertiary-care pediatric centers, there are experienced social workers and dedicated teams of health care professionals whose job it is to deal with the myriad social and legal issues involved in these cases. For physicians, it is important to meticulously document every aspect of the child’s care and not to compound the injuries with a diagnostic or therapeutic misstep.

The perpetrator is very often an adult guardian (it is astonishing how often a single mother’s boyfriend is the culprit) but it seems increasingly common to see older siblings, cousins, and peers involved. What might have been ascribed an accident or horse play could very well have been a deliberate act perpetrated by a bully. It is important to identify these patterns because it is disturbingly common to see a child returned home to a dangerous environment only to come back later with a more serious injury.

Diagnostic Studies

Chest X-ray

Skeletal survey

Bone scan

Computed tomography (brain, abdomen, and/or chest)

Ophthalmologic examination for retinal hemorrhages