Child abuse has its own proportions as a social and medical problem.
The number of abused and neglected children in the United States rose from
1.4 million in 1986 to 2.9 million in 1993.[1] We all may agree that its
actual incidence is unknown and many cases are unreported. Unfortunately,
the problem is still identified in retrospect after a history of
repetitive trauma has been established. [2, 3]
Awareness of the skeletal signs of abuse in children is important for
physicians as well as the other injury patterns in order to diagnose and
intervene appropriately. Whereas the incidence of non-accidental fractures
decreases with increasing age, the incidence of accidental fractures
increases with increasing age up to 12 years.[4]
Civil suits have been filed against physicians for failure to report
acts of child abuse. Maliciously reporting abuse when it is not the cause
of injury, however, may expose an individual to the risk of litigation.
The caregiver's account of the injury is often vague. The degree of
physical injury may be inconsistent with the history given [5, 6, 7] and
often the reported time of injury does not correlate with the obvious age
of the injury. A delay in seeking treatment is often noted. However, a
history of repeated trauma with the child treated in several different
facilities should arouse suspicion. The parents' response to the situation
may be inappropriate. They may become overly involved. [8]
Any condition that interferes with parent-child bonding and contact
increases the risk of child abuse. Premature infants, hyperactive children
or children with disabilities are more likely to suffer abuse.[9] Because
infanticide occurs most often in the first few months of life,
intervention during pregnancy and the postpartum period is
recommended.[10] Early identification and intervention are essential.
Recognition of signs of neglect, sexual abuse, or emotional maltreatment
may lead the treating physician to consider non-accidental injury as a
possibility.
References:
1. Anonymous : Child Maltreatment 1994: Reports from State to the
National Center on Child Abuse and Neglect, Washington, DC, National
Center on Child Abuse Neglect, U.S. Government Printing Office, 1996.
2. Gross R.H., Stranger M.: Causative factors responsible for femoral
fractures in infants and young children. J Pediatr Orthop 1983; 3:341-
343.
3. Jackson G.: Child abuse syndrome: The cases we miss. BMJ 1972;
2:756-757.
Rapid Response:
Our tunnel view may miss a child abuse
Child abuse has its own proportions as a social and medical problem.
The number of abused and neglected children in the United States rose from
1.4 million in 1986 to 2.9 million in 1993.[1] We all may agree that its
actual incidence is unknown and many cases are unreported. Unfortunately,
the problem is still identified in retrospect after a history of
repetitive trauma has been established. [2, 3]
Awareness of the skeletal signs of abuse in children is important for
physicians as well as the other injury patterns in order to diagnose and
intervene appropriately. Whereas the incidence of non-accidental fractures
decreases with increasing age, the incidence of accidental fractures
increases with increasing age up to 12 years.[4]
Civil suits have been filed against physicians for failure to report
acts of child abuse. Maliciously reporting abuse when it is not the cause
of injury, however, may expose an individual to the risk of litigation.
The caregiver's account of the injury is often vague. The degree of
physical injury may be inconsistent with the history given [5, 6, 7] and
often the reported time of injury does not correlate with the obvious age
of the injury. A delay in seeking treatment is often noted. However, a
history of repeated trauma with the child treated in several different
facilities should arouse suspicion. The parents' response to the situation
may be inappropriate. They may become overly involved. [8]
Any condition that interferes with parent-child bonding and contact
increases the risk of child abuse. Premature infants, hyperactive children
or children with disabilities are more likely to suffer abuse.[9] Because
infanticide occurs most often in the first few months of life,
intervention during pregnancy and the postpartum period is
recommended.[10] Early identification and intervention are essential.
Recognition of signs of neglect, sexual abuse, or emotional maltreatment
may lead the treating physician to consider non-accidental injury as a
possibility.
References:
1. Anonymous : Child Maltreatment 1994: Reports from State to the
National Center on Child Abuse and Neglect, Washington, DC, National
Center on Child Abuse Neglect, U.S. Government Printing Office, 1996.
2. Gross R.H., Stranger M.: Causative factors responsible for femoral
fractures in infants and young children. J Pediatr Orthop 1983; 3:341-
343.
3. Jackson G.: Child abuse syndrome: The cases we miss. BMJ 1972;
2:756-757.
4. Worlock P., Stower M.: Fracture patterns in Nottingham children. J
Pediatr Orthop 1986; 6:656-660.
5. Abuse Child : Guidelines for Intervention by Physicians and Other
Health Care Providers, Seattle, Washington State Medical Association,
1990.
6. Everything You Always Wanted To Know about Child Abuse and Neglect,
Washington, D.C., National Center on Child Abuse and Neglect, 1991.
7. Helfer R.E., Slovis T.L., Black M.: Injuries resulting when small
children fall out of bed. Pediatrics 1977; 60:535-553.
8. Green F.C.: Child abuse and neglect, a priority problem for the
private physician. Pediatr Clin North Am 1975; 22:329-339.
9. Albert M.J., Dvaric D.M.: Injuries resulting from pathologic forces:
Child abuse. In: MacEwen G., Kasser J.R., Heinrick S.D., ed. Pediatric
Fractures: A Practical Approach to Assessment and Treatment, Baltimore:
Williams & Wilkins; 1993: 388-400.
10. Overpeck M.D., Brenner R.A., Trumble A.C., et al: Risk factors for
infant homicide in the United States. N Engl J Med 1998; 339:1211-1216.
Competing interests:
None declared
Competing interests: No competing interests