Child Abuse

Question 1

Mention CCC of skeletal injuries caused by child abuse

Answer 1

Characterized by multiple bilateral fractures of various ages
1. Classical metaphyseal fracture of long bones, skull, ribs, sternal and vertebral fractures are highly suggestive of abuse
2. Antero-posterior compression causes fractures along the mid-axillary line. Side-to-side compression causes multiple rib fractures along the posterior angle of ribs. After 1-2 weeks, callus is formed.
3. Clavicular fractures, simple linear skull fractures and diaphyseal fractures may also be present

Question 2

Mention CCC of burns caused by child abuse

Answer 2

A. Scalds: of buttocks and thicks accompanied by perineal or foot inkuries which spare the flexion creases OR symmetric burns of hands or feet (sharp stocking and glove, sparing of flexed protected areas) with clear demarcation lines are classic for forced submersion injuries
B. Dry burns: patterned injury could be seen as clear pattern of the hot object (esp in the back, buttocks and outer sides of arms and legs. Typical cigarette burn is rounded to slightly oval, often with a central depression between 0.5 to 1 cm. They have ehomogenous depth

Question 3

Mention history indicators of the presence of child abuse

Answer 3

1. Inconsistent history details that change over time
2. Caregivers give doubtful details not congruent with observed trauma
3. Serious injury is blamed to be inflicted by younger sibling or playmate
4. Caregivers frequently changes healthcare facilities, pediatricians or emergency departments

Question 4

Mention examination indicators of the presence of child abuse

Answer 4

1. Poor hygeine
2. Injury pattern inconsistent with history provided
3. Multiple injuries of the same type and different types of injuries are present at the same time (bruises, burn, fractures..etc,)
4. Injuries and fractures at various stages of healing

Question 5

List CNS effects of shaken baby syndrome

Answer 5

1. Subdural or subaachnoid hemorrhage
2. Cerebral contusion
3. Concussion or DAI
4. Retinal hemorrahges and detachment

Question 6

Mention physcial signs of the presence of child sexual abuse

Answer 6

1. Bleeding, bruises or swelling in genital area
2. Bloody, torn or stained underclothes
3. Difficulty in walking or sitting
4. Frequent urinary or yeast infections
5. Pain, itching or burning in the genital area
6. Pregnancy

Question 7

Mention behavioral signs of the presence of child sexual abuse

Answer 7

1. Changes in hygiene such as refusing to bath or bathing excessively
2. Develops phobias, signs of depression and suicidal thoughts esp in adolescence
3. School troubles such as absences and drop in grades
4. Nighet mare and bed-wetting
5. Runs away from home or school

Question 8

List physical, behavioral and psychological effects of child abuse

Answer 8

Physcial: severe brain damage, disfigurement or blindness, crippling and death.
Behavioral: illegal or violent behavior and abuse of others. Suicide attempts or self-injury, high-risk of sexual behaviors, problems in school, limited socal and relationship skills.