Child Abuse and Neglect

Question 1

What factors point towards child abuse?

Answer 1

1. Story inconsistent with injuries
2. Repeated attendances at A&E departments
3. Late presentation
4. Child with a frightened, withdrawn appearance - ‘frozen watchfulness’

Question 2

What are some physcial appearances of child abuse?

Answer 2

1. Bruising
2. Fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing
3. Torn frenulum: e.g. from forcing a bottle into a child’s mouth
4. Burns or scalds
5. Failure to thrive
6. Sexually transmitted infections e.g. Chlamydia, Gonorrhoea, Trichomonas

Question 3

What are the features of childhood sexual abuse?

Answer 3

1. Pregnancy
2. sexually transmitted infections, recurrent UTIs
3. sexually precocious behaviour
4. anal fissure, bruising
5. reflex anal dilatation
6. enuresis and encopresis
7. behavioural problems, self-harm
8. recurrent symptoms e.g. headaches, abdominal pain