Child Abuse

RED FLAGS

  • Failture to thrive (FTT), developmental delay
  • Poor hygiene (dental, dirty clothes)
  • No stranger anxiety, decreased attachment to parent
  • Prolonged interval before presentation
  • Conflicting histories
  • Doctor shopping
  • Unrelated signs of injuries

History

  • What is the incident?
  • Witnessed by person providing history?
  • Does the history adequately explain the injury?
  • Consistency? Detailed? Same account for all involved? Dominant historian?

Physical

  • Bruises
    • Location (accessibility)
    • Shape
    • Size (always measure)
    • Recording (draw, photograph)
    • Colour
  • Fractures: especially of skull, long bones, ribs
  • Mechanism of injury (force applied, amount needed)
  • Burns
  • Head injury (subdural – irritable, lethargic, poor feeding, increased ICP, retinal hemorrhage)
  • Eye injury
  • Internal injury

– TAKE A GOOD HISTORY
– DO A PROPER PHYSICAL EXAM
– DOCUMENT INJURIES
– APPROPRIATE INVESTIGATIONS (XRAY, BONE SCAN, CT, US, BLOODWORK)
– ALERT CHILD WELFARE
– SOCIAL WORK CONSULT
– ENSURE SAFETY OF CHILD AND OF OTHER CHILDREN

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