CHILD ABUSE (Physical Signs)

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CHILD ABUSE (Physical Signs):

• This lecture aims on how to recognize key physical signs of child abuse.

Failure to thrive:

• Persistent weight loss, malnutrition, and stunted growth can indicate neglect, indicative of child abuse.
• Poor hygiene such as unkempt appearance, dirty clothes, and matted hair may suggest neglect or emotional abuse.

Facial injuries:

• Unexplained facial Injuries such as bruises, cuts, or swelling on the face, especially in specific locations like the ears, cheeks, or lips, warrant further investigation.

Slap marks:

• Slap marks or hand-shaped bruises on the face or buttocks, can be indicative of physical abuse.

Oral injuries:

• Torn or bruised frenulum can occur due to "bottle jamming" during forced feeding.
• Scarring or bruising around the mouth may suggest gagging or smothering.
• Oral injuries such as mouth sores, chipped teeth, and sexually transmitted infections can point towards forced oral sex.

Unexplained bruises:

• Be wary of unexplained bruises or wounds in unusual locations, particularly on the buttocks, thighs, abdomen, or back. 
• Consider the size, shape, and distribution of bruises for patterns suggestive of abuse.
• Restraint marks on limbs, axilla, or neck may indicate the use of restraints.

Loop marks:

• Loop marks are pathognomonic for abuse and result from striking the child with a cord, rope, or belt.
• Bruises or scrapes on forearms, hands, or legs may indicate defensive injuries attempting to repel blows.

Inflicted burns:

• Inflicted burns include immersion burns, scalded burns, and cigarette burns.

Immersion burns:

• Immersion burns are burns with sharp lines of demarcation and no splash marks suggest submersion in hot liquid, a potential sign of abuse.

Scald burns:

• Scald burns are the most common burn type in children who have been abused and the most common causative agent is tap water. 
• Abusive scalds tend to be distributed on the buttocks, perineum, and lower extremities, with clear upper limits and scald symmetry, especially when present on the lower extremities.
  

Cigarette burns:

• Cigarette burns are round, well-defined burns with central charring points that can be indicative of intentional abuse.

Ear Injuries:

• Ear Injuries such as bruising, bleeding, or ruptured eardrums can occur due to blows or objects inserted into the ear, suggesting potential abuse.

Ocular Injuries

• Blood in the anterior chamber of the eye, hyphema,  can be caused by blunt force trauma to the head.
• Retinal hemorrhage is a potential indicator of abuse, it can be caused by blunt head trauma.
• Retinal detachments can occur due to significant head trauma, raising concerns for abuse.

Brain Injuries:

• Subdural hematoma, especially if bilateral, can be caused by significant head trauma, often linked to abuse.
• Abusive head trauma, also known as Shaken baby syndrome,  is a head or neck injury from physical child abuse. 
• It happens when someone violently shakes a baby or hits the baby against something hard, leading to brain injuries even without external signs of trauma. 
• Symptoms can include irritability, vomiting, lethargy, seizures, and coma.
• Abusive head trauma may be associated with retinal hemorrhage, multiple fractures of the long bones, and subdural hematomas.

Skeletal Injuries: 

• Skeletal Injuries suggestive of child abuse include: long bone spiral fractures, corner fractures, and posterior rib fractures.

​Spiral fractures:

• Long bone spiral fractures are uncommon in accidental falls.
• Spiral fractures are more suggestive of twisting forces, potentially caused by abuse in children.

​Corner fractures:

• Corner fractures, also known as bucket handle fractures, are observed in young children and are suggestive of non-accidental injury, child abuse. 

Posterior rib fractures:

• Most rib fractures in infants are caused by child abuse.
• Posterior rib fractures, especially multiple and in younger children, are rarely accidental and warrant further investigation.

Abdominal trauma: 

• Abdominal trauma is the second most common cause of death in children who have been abused.
• Severe abdominal injuries are unlikely to result from minor or household trauma.
• Young children who present with serious abdominal injuries in the absence of major trauma, such as a motor vehicle crash, should be carefully evaluated for the possibility of physical abuse.

Sexual assaults: 

• Sexual assaults include genital or rectal injuries. 
• Bruising, tearing, bleeding, or discharge from these areas can be signs of sexual abuse.
• Diagnosed sexually transmitted infections or pregnancy in pre-pubertal children are highly concerning for sexual abuse.

SUMMARY:

• Healthcare professionals can play a vital role in identifying and protecting vulnerable children.
• Maintain a non-judgmental and supportive approach when interacting with the child and family.
• Remember, the presence of any single sign does not confirm abuse. 

• Report suspected abuse to the appropriate authorities as mandated by law and local protocols.