child abuse
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Introduction
Includes:
Epidemiology
- effects 750,000 annually in USA[5]
- 2250 deaths from abusive head trauma in children < 5 years of age 1999-2014[11]
- poverty is associated with higher rates of child abuse
Clinical manifestations
- inconsistent or unclear explanation for injury
- bruises, lacerations & burns may be suspect
- bruises in well padded areas (buttocks, cheeks, thighs) are suspect, bruises on anterior surfaces (shins) are generally accidental
- burns from immersion are generally well demarcated, accidental burns often have a scatter pattern
- fractures[9]
- fracture with no history of injury
- fracture is in a nonambulatory child
- rib, scapular, sternal, & spinous process fractures
- multiple fractures or fractures of different ages
- history inconsistent with injury sustained
- inconsistent or changing histories.
- multiple suspicious injuries
- any injury to an infant who's not yet mobile[10]
- injuries in atypical areas (e.g., torso, ears)
- various injuries at different healing stages
- trauma to more than one organ system
- symptoms that might indicate head trauma, such as unexplained vomiting, lethargy, irritability, apnea, or seizures[10]
- delay in seeking medical treatment.
Laboratory
- labs for abdominal pain (if abdominal injury)
- urine drug screen[6]
- laboratory results that suggest a bleeding disorder do not rule out child abuse[7]
Diagnostic procedures
Radiology
- skeletal X-rays to identify fractures
- CT or MRI of brain for head injury even in neurological exam is normal (if < 4 years of age)[2]
Complications
- child-abuse may increase likelihood of perpetration of domestic violence as adult [4
- child-abuse or harsh punishment in childhood may be risk factor for antisocial personality disorder[15]
- childhood abuse may be associated with sperm demethylation[14]
Management
- referral to a child-abuse team
- examination of sibling[11]
- not enough evidence to recommend for or against primary care interventions, such as home visitation programs, to prevent child abuse among at-risk children[8]
- clinicians who have 'a reasonable suspicion of abuse' are obligated by law to report their concerns to Child Protective Services[10]
More general terms
References
- ↑ Journal Watch 23(14):109, 2003 Rubin DM et al, Pediatrics 111:1382, 2003
- ↑ 2.0 2.1 Journal Watch 24(16):127, 2004 Laskey AL, Holsti M, Runyan DK, Socolar RR. Occult head trauma in young suspected victims of physical abuse. J Pediatr. 2004 Jun;144(6):719-22. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15192615
Hymel KP. Traumatic intracranial injuries can be clinically silent. J Pediatr. 2004 Jun;144(6):701-2. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15192612 - ↑ Kellogg N; American Academy of Pediatrics Committee on Child Abuse and Neglect. The evaluation of sexual abuse in children. Pediatrics. 2005 Aug;116(2):506-12. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/16061610 <Internet> http://pediatrics.aappublications.org/cgi/content/full/116/2/506
- ↑ Holmes WC, Sammel MD. Brief communication: physical abuse of boys and possible associations with poor adult outcomes. Ann Intern Med. 2005 Oct 18;143(8):581-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16230724
- ↑ 5.0 5.1 Kellogg ND and the Committee on Child Abuse and Neglect. Evaluation of suspected child physical abuse. Pediatrics 2007, 119:1232 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17545397
Dubowitz H and Bennet S Physical abuse and neglect of children Lancet 2007, 369:1891 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17544770 - ↑ 6.0 6.1 Oral R et al. Illicit drug exposure in patients evaluated for alleged child abuse and neglect. Pediatr Emerg Care 2011 Jun; 27:490. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21629147
- ↑ 7.0 7.1 Anderst JD et al Evaluation for Bleeding Disorders in Suspected Child Abuse. Pediatrics. March 25, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23530182 <Internet> http://pediatrics.aappublications.org/content/early/2013/03/18/peds.2013-0195.full.pdf+html
Carpenter SL et al Evaluating for Suspected Child Abuse: Conditions that Predispose to Bleeding. Pediatrics. March 25, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23530171 <Internet> http://pediatrics.aappublications.org/content/early/2013/03/18/peds.2013-0196.full.pdf+html - ↑ 8.0 8.1 Moyer VA et al Primary Care Interventions to Prevent Child Maltreatment: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 11 June 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23752681 <Internet> http://annals.org/article.aspx?articleid=1696071
- ↑ 9.0 9.1 Flaherty EG et al Evaluating Children with Fractures for Child Physical Abuse. Pediatrics. Published Online Jan 27, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24470642 <Internet> http://pediatrics.aappublications.org/content/early/2014/01/22/peds.2013-3793.full.pdf+html
- ↑ 10.0 10.1 10.2 10.3 Christian CW The Evaluation of Suspected Child Physical Abuse. Pediatrics. April 27, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25917988 <Internet> http://pediatrics.aappublications.org/content/early/2015/04/21/peds.2015-0356.full.pdf+html
- ↑ 11.0 11.1 11.2 Spies EL, Klevens J. Fatal Abusive Head Trauma Among Children Aged < 5 Years - United States, 1999-2014. MMWR Morb Mortal Wkly Rep 2016;65:505-509 http://www.cdc.gov/mmwr/volumes/65/wr/mm6520a1.htm
- ↑ Berkowitz CD Physical Abuse of Children. N Engl J Med 2017; 376:1659-1666. April 27, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28445667 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcp1701446
- ↑ Centers for Disease Control & Prevention (CDC) Injury Prevention & Control : Division of Violence Prevention Essentials for Childhood Framework: Steps to Create Safe, Stable, Nurturing Relationships and Environments for All Children. http://www.cdc.gov/violenceprevention/childmaltreatment/essentials.html
- ↑ 14.0 14.1 Roberts AL, Gladish N, Gatev E et al. Exposure to childhood abuse is associated with human sperm DNA methylation. Transl Psychiatry. 2018 Oct 2;8(1):194. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30279435 Free PMC Article
- ↑ 15.0 15.1 Afifi TO, Fortier J, Sareen J et al. Associations of harsh physical punishment and child maltreatment in childhood with antisocial behaviors in adulthood. JAMA Netw Open 2019 Jan 4; 2:e187374 Not indexed in PubMed https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2722572
- ↑ National Resource Center for Child Protective Services http://nrccps.org/