Child abuse

Question 1

DEFINITION

Answer 1

“A non-accidental repetitive neglect, sexual, emotional or physical maltreatment causing minimal as well as fatal injuries inflicted upon infants or children by their parents or other caretakers”

Question 2

General features:

Answer 2

There are four general features that should make doctors suspicious that they are dealing with injuries that are the result of physical child abuse.

1- If the child has suffered from repeated injuries;

2- If there is a delay in seeking medical assistance by the carers;

3- If the child has been taken to different hospitals or doctors for treatment of the different injuries.

4- If the explanation(s) given by the carers does not correlate with the type or the extent of the injuries that are present on the child.

Question 3

Neonaticide

Answer 3

Killing of a premature or full term baby within 24 hours after birth usually by young single uneducated mother (act of commission or omission).

Question 4

Infanticide

Answer 4

Killing of the newly born, live born infant within 12 months after birth.

Question 5

Euthanasia

Answer 5

Killing of a handicapped (physical, mental or both) child usually under 3 years by a parent

Question 6

Murder-suicide

Answer 6

Parents are always depressed. Often whole family is killed usually in one accident

Question 7

Murder-homicide

Answer 7

The great majority of victims are girls after sexual assaults..

Question 8

etiology of child abuse

Answer 8

Question 9

etiology of child abuse cont.

Answer 9

Question 10

Medicolegal investigation of a case of child abuse

Answer 10

1- Medical history:

2- Characteristic signs:

A. General signs

B. Examination of the child:

3- Radiological examination:

Question 11

I- Medical History

taking must be in the form of non-leading questions, recorded in a hospital chart or on videotape, and in the presence of an independent adult witness:

Answer 11

1. Delay in reporting or treatment.
2. Discrepancy in stories.
3. S/S & history changing after initial presentation.
4. Discrepancy between history & physical findings.
5. Injuries were blamed upon another child or accident.

Question 12

II. Characteristic signs:

Answer 12

A. General signs highly suggestive of child abuse:

1. The child may be alert or apathic or in fear.
2. Injuries appear older than the alleged history.
3. Presence of different types of injuries e.g. fractures together with burns of different kinds.
4. Presence of multiple lesions of different ages (recent and old).
5. Multiple lesions from a single cause (e.g. 2 separate cigarette burns).
6. Unusual soft issue injuries e.g. avulsion of frenulum of the lips.
7. The suspected lesions are covered by sticking plasters, clothes.

Question 13

B. Examination of the child:

Answer 13

(A) Clothing: examination for cleanliness, quality, suspected stains.

( B) Photography: colored photographs of all injuries.

(C) Regional examination:

Question 14

. Head:

Scalp bruises are easily felt. Skull fractures are common.

The most common fractures lie in

Answer 14

the occipito-parietal area leading to brain damage.

Question 15

Suture diastases may occur with or without fractures. Skull fractures are often associated with

Answer 15

subdural hemorrhage.

Question 16

Bruises inside the lips, lacerations and torn frenulum are pathognomonic sign of

Answer 16

deliberate child abuse.

Question 17

Eyes:

Answer 17

black eyes, conjunctival and scleral hemorrhages, vitreous hemorrhage, lens dislocation and retinal hemorrhage.

Question 18

Ear:

Answer 18

external ear injuries e.g. pinnae bruises and lacerations. Inner ear impacts may cause deafness.

Question 19

Finger tips bruises on the sides of the cheek across the mouth to

Answer 19

§stop the child crying.

Question 20

Teeth:

Answer 20

Loosening, breakage even total avulsion of teeth from the sockets.

Question 21

The shaken baby syndrome (Caffeys’ syndrome): It is characterized by

Answer 21

retinal, subdural and/or subarachnoid hemorrhages. It is caused by severe shaking.

Question 22

2. Neck:

Answer 22

Neck bruises from fingers pressure in asphyxial trials.

Question 23

3. Chest:

Answer 23

Different levels of bruises over the costal margin and scapulae

when gripping the child from behind with both hands.

Multiple rib fractures and callus formation that gives string beaded appearance in X-ray.

Single rib fracture.

Pulmonary contusion and rupture heart are rare.

Question 24

4. Abdomen:

Answer 24

• Liver and pancreas ® hemorrhage and laceration.
• Stomach ® traumatic rupture.
• Small intestine ® bowel ruptures especially duodenum.
• These are produced by compression or kneeling on the child.

Question 25

5. Limbs :

Answer 25

• Bruises around the joints from gripping in order to swing or shake the infant.
• Fractures at any site in diaphysis, may be multiple.
• Spiral fractures indicate twisting injury.
• Avulsion of parts of metaphysis and slipped epiphysis are caused by traction.

Question 26

Bites

Answer 26

We must differentiate between abuser bites, other children

bites and self-inflicted bites that are within the reach of the

child to restrain his own screams.

Favorite sites: are arms, back of hands, cheeks, shoulders and buttocks.

Shape: consists of two opposing semicircles with abrasion, contusion or both.

Size: size of the dental arch determines whether it is done by an adult, child or animal.

Question 27

7. Burns:
   a. Dry burns:

Answer 27

Burns : buttocks and perineum.

By : hot plates, irons or hot metals.

Cigarette burns (multiple-different ages , on areas normally covered by clothing)

Question 28

b. Scalds from:

Answer 28

Over hot bath water.

Deliberate pouring of hot water.

Dipping in hot liquid.

It shows clear cut line of immersion.

Question 29

8. Poisoning:

Answer 29

It occurs more with baby sitters. The drugs used more are antihistamines, cough mixtures and laxatives

Question 30

III. Radiological examination:

Answer 30

• X-ray skull, chest, abdomen and the whole skeleton to discover the extent of acute injuries as well as to disclose the presence of healed lesions.
• Computed tomography scan (CT): to assess brain injury and intracranial hemorrhage.
• Magnetic resonance imaging (MRI): It is more sensitive to small subdural and subarachnoid hemorrhages, contusions of cortex and deep white matter lesions.