Sadly child abuse is now a relatively common problem within our society and it takes on many forms.
It can include physical abuse (broken bones, brain injury, bites and burns), Sexual abuse,
Psychological abuse and the most common type - Neglect.

Injuries seen in abuse are often distinctive because they are inflicted by adults, so therefore
will be significantly more violent or purposeful than injuries sustained during normal childhood activities.

Consideration of the history of the explanation is always important in any childhood injury.
This must also be correlated with the developmental stage of the child. A 2 month old baby cannot,
for example, fall downstairs by itself. This isn't because the baby can't fall, because it can.
It has more to do with the fact that a child this young would be unable to manoeuvre to the edge of
the stairs. A baby could certainly be dropped downstairs unintentionally, but a well intentioned carer
who accidentally drops a child will go on to describe the incident as it actually happened.
An abusive carer on the other hand, may give an evasive, inaccurate and implausible history such
as 'She was at the top of the stairs and rolled down'

When we look properly at the story, we can see how implausible it really is.
Similarly consider this reason cited for a skull fracture in a 4 year old : An 18 month old
sibling hit him with a baseball bat. Swinging a bat (even being able to lift it!) forcibly enough
to break a skull demonstrates considerable force and muscular co-ordination - Probably far more
than an 18 month old toddler could enforce.

In addition to considering the history of the injury we should also consider the nature of the injury itself.
There are some injuries and injury patterns that are highly suggestive of abuse.
If such injuries are discovered and acted upon, these children can be spared further
trauma, as can any siblings



Injuries Suggestive of Child Abuse

  • Bruises on the face, lips, mouth, torso, back, buttocks or thighs

  • Especially in various stages of healing

  • Degree of bruising is greater than expected for the activity level of the child

  • Bilateral black eyes (Raccoon Eyes)



Skeletal Injuries

  • Fractures of the ribs, ends of long bones (Near growth plates)

  • Spinal

  • Multiple fractures

  • Fractures of differing ages

  • Any fracture inconsistent with the development and capabilities of the child



Head Injuries

  • Bleeding onto/into the brain (Subdural Haemorrhage)

  • Brain swelling (Cerebral Oedema)

  • Multiple Skull fractures ('Eggshell' Fractures)
     

Abdominal Injuries

  • Small bowel injury (Duodenal of jejunal haematoma, bowel laceration)

  • Pancreatitis or pancreatic injury

  • Injury to the liver, spleen or adrenal glands



Signs Of Neglect

  • Lack of appropriate hygiene

  • Inappropriate dress

  • Bald spots

  • Severe nappy rash

  • Failure to thrive

  • Lack of immunisations

  • Lack of dental care

  • Lack of supervision

  • Abandonment



Suspicious Histories

  • No explanation for the injury

  • Inadequate explanation

  • Contradictory or changing history

  • Injury attributed to a 3rd party (Sibling, childminder etc..)

  • Has unrealistic expectations of the child
    (to be behaviourally more mature)

  • Lack of concern or detachment to the injury

  • Lack of response to a child in pain

  • Overly concerned about trivial injuries

  • Lack of trust in health professionals

  • Parents themselves have a history of :

    • Drug or alcohol addiction

    • Psychosis

    • Abuse in their own childhood

     






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