Definition
The physical signs of child abuse used to be called battered child syndrome. This syndrome referred to multiple fractures in different states of healing. The fractures occurred at different times in children too young to have received the fractures as a result of an accident.
The definition of child abuse has since expanded significantly. Physical child abuse or non-accidental child trauma refers not only to multiple fractures at different ages, but it also includes numerous other signs of injury.
See also:
Alternative Names
Battered child syndrome; Physical abuse - children
Causes, incidence, and risk factors
Physical abuse tends to occur at moments of greatest stress, when someone strikes out in anger at the child. Many of those who commit physical abuse have been abused themselves as children. As a result, they often do not realize that abuse is not appropriate discipline. Those who commit physical abuse also frequently have poor impulse control, which prevents them from thinking about what happens as a result of their actions.
Because adults are so much stronger and bigger than children, an abused child can be severely injured or killed by accident. For example, shaking an infant, especially if the head hits something, even against a soft object like a mattress or pillow, can cause bleeding over the brain (subdural hematoma). This can cause permanent brain damage or death. (See shaken baby syndrome.)
Unfortunately, the rate of child abuse is fairly high. The most common form is neglect. Child abuse accounts for at least 1,400 deaths in children each year.
The major risk factors for someone to abuse another person include:
- Poverty
- Lack of education
- Being a single parent
- Alcoholism
- Other drug abuse
Symptoms
Adult may bring an injured child to an emergency room with a strange explanation of the cause of the injury. The child's injury may not be recent.
Symptoms include:
- Broken bones that are unusual and unexplained
- Bruise marks shaped like hands, fingers, or objects (such as a belt)
- Bruises in areas where normal childhood activities would not usually result in bruising
- Burn (scalding) marks, seen when a child is placed in hot water as a punishment -- particularly "glove" or "sock" burn patterns
- Burns from an electric stove, radiator, heater or other hot objects, usually seen on the child's hands, arms or buttocks
- Cigarette burns on exposed areas or the genitals
- Black eyes in an infant or a similar, unexplained injury in a child
- Human bite marks
- Lash marks
- Choke marks around neck
- Circular marks around wrists or ankles (indicating twisting or tying up)
- Separated sutures
- Bulging fontanelle
- Evidence of unexplained abdominal injury (such as bruised or ruptured intestines due to punching)
- Unexplained unconsciousness in infant
Signs and tests
Typical injuries in abused children include:
- Bleeding in the back of the eye, seen with shaken baby syndrome or a direct blow to the head
- Internal damage, such as bleeding or rupture of an organ from blunt trauma
- Any fracture in an infant too young to walk or crawl
- Evidence of fractures at the tip of long bones or spiral-type fractures that result from twisting
- Fractured ribs, especially in the back
- Evidence of skull fracture (multiple fractures of different ages may be present)
- Subdural hematoma (collection of blood in the brain) without plausible explanation
- Multiple bruises that occured at different times -- especially in unusual areas of the body or in patterns that suggest choking, twisting, or severe beating with objects or hands
- Other unusual skin damage, including burns or burn scars
The following tests can reveal physical injuries:
- Bone x-ray -- a skeletal survey is done whenever physical abuse is suspected. All the child's bones, including the skull, are x-rayed to look for unseen fractures or old, healing fractures.
- MRI or CT scan of the head or abdomen are done if there is a skull fracture, bleeding in the eye, unexplained vomiting, severe bruising of the face, skull or abdomen, or unexplained neurological symptoms, headaches, or loss of consciousness.
The following medical conditions have symptoms similar to physical abuse:
- Osteogenesis imperfecta - almost all children with this condition have an abnormal (blue) coloring of the whites of the eyes. These children may have spontaneous fractures or break bones after normal accidents that would not harm the bones of a normal child.
- Undetected bleeding disorders such as hemophilia, Von Willebrand's disease, or liver disease can lead to abnormal bruising patterns. The doctor can test for these disorders.
- Unusual bruising and scarring patterns can also be caused by folk medicine or Oriental medicine practices such as coin rubbing, cupping, and burning herbs on the skin over acupuncture points (called moxibustion). The doctor should always ask about alternative healing practices.
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