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Abstract
The clinical approach to the evaluation of suspected physical abuse in children is briefly reviewed in this article. Child physical abuse refers to the infliction of injury on any part of a child's body. In 2006, 5,202 children were confirmed to be victims of child abuse in Korea. Among them 35% were classified as physical abuse. The physical abuse has usually been underreported because most injuries of childhood are not the result of abuse and an injury pattern is rarely pathognomonic for abuse or accident without careful consideration of the explanation provided. The medical assessment is outlined with respect to obtaining a history, physical examination, clinical manifestation, and appropriate ancillary testing. Detection of physical abuse is dependent on the doctor's ability to recognize suspicious injuries, such as bruising, bite marks, burns, and bone fractures. The physician should be able to recognize suspicious injuries, conduct a comprehensive and careful examination with appropriate auxiliary tests, critically assess the explanation provided for the injury, and establish the probability that the explanation does or does not correlate with the pattern, severity, and age of the injury. Suspected cases of child abuse should also be well documented and reported to the appropriate public agency which should assess the situation and help to protect the child.
References
1. Ministry of health and welfare, National Child Protection Agency. Report on national status of child abuse. 2007. (Korea 1391.org).
2. Pless IB, Sibald AD, Smith MA, Russell MD. A reappraisal of the frequency of child abuse seen in pediatric emergency rooms. Child Abuse Negl. 1987; 11:193–200.
3. Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. JAMA. 1999; 281:621–626.
4. McDonald KC. Child abuse: approach and management. Am Fam Physician. 2007; 75:221–228.
5. Ahn DH. Physician's role on prevention and treatment of child abuse. J Korean Med Assoc. 2002; 45:1280–1290.
6. Lee MS. Child abuse and doctor's responsibility. J Korean Med Assoc. 2002; 45:1299–1304.
7. People's Medical Knowledge Enhancing Committee. Guideline for doctor's on protection and treatment.
8. Hettler J, Greenes DS. Can the initial history predict whether a child with a head injury has been abused? Pediatrics. 2003; 111:602–607.
9. Wagner GN. Crime scene investigation in child?abuse cases. Am J Forensic Med Pathol. 1986; 7:94–99.
10. Kellogg N. Oral and dental aspects of child abuse and neglect. Pediatrics. 2005; 116:1565–1568.
11. Crouse CD, Faust RA. Child abuse and the otolaryngologist: part II. Otolaryngol Head Neck Surg. 2003; 128:311–317.
12. Saraswat A. Child abuse and trichotillomania. BMJ. 2005; 330:83–84.
13. Naidoo S. A profile of the oro?facial injuries in child physical abuse at a children's hospital. Child Abuse Negl. 2000; 24:521–534.
14. Dunstan FD, Guildea ZE, Kontos K, Kemp AM. A scoring system for bruise patterns: a tool for identifying abuse. Arch Dis Child. 2002; 86:330–333.
15. Carpenter RF. The prevalence and distribution of bruising in babies. Arch Dis Child. 1999; 80:363–366.
16. Maguire S, Mann MK, Sibert J, Kemp A. Are there patterns of bruising in childhood which are diagnostic or suggestive of abuse? A systematic review. Arch Dis Child. 2005; 90:182–186.
17. When inflicted skin injuries constitute child abuse. Pediatrics. 2002; 110:644–645.
18. Hettler J, Greenes DS. Can the initial history predict whether a child with a head injury has been abused? Pediatrics. 2003; 111:602–607.
19. Feldman KW. Patterned abusive bruises of the buttocks and the pinnae. Pediatrics. 1992; 90:633–636.
20. Jessee SA. Orofacial manifestations of child abuse and neglect. Am Fam Physician. 1995; 52:1829–1834.
21. Oral and dental aspects of child abuse and neglect. American Academy of Pediatrics. Committee on Child Abuse and Neglect. American Academy of Pediatric Dentistry. Ad Hoc Work Group on Child Abuse and Neglect. Pediatrics. 1999; 104:348–350.
22. Dailey JC, Bowers CM. Aging of bitemarks: a literature review. J Forensic Sci. 1997; 42:792–795.
23. Wilson EF. Estimation of the age of cutaneous contusions in child abuse. Pediatrics. 1977; 60:750–752.
24. Stephenson T, Bialas Y. Estimation of the age of bruising. Arch Dis Child. 1996; 74:53–55.
25. Bariciak ED, Plint AC, Gaboury I, Bennett S. Dating of bruises in children: an assessment of physician accuracy. Pediatrics. 2003; 112:804–807.
26. Maguire S, Mann MK, Sibert J, Kemp A. Can you age bruises accurately in children? A systematic review. Arch Dis Child. 2005; 90:187–189.
27. Hight DW, Bakalar HR, Lloyd JR. Inflicted burns in children. Recognition and treatment. JAMA. 1979; 242:517–520.
28. Andronicus M, Oates RK, Peat J, Spalding S, Martin H. Non? accidental burns in children. Burns. 1998; 24:552–558.
29. Stewart GM, Rosenberg NM. Conditions mistaken for child abuse: part II. Pediatr Emerg Care. 1996; 12:217–221.
30. Alexander RC, Surrell JA, Cohle SD. Microwave oven burns to children: an unusual manifestation of child abuse. Pediatrics. 1987; 79:255–260.
31. Frechette A, Rimsza ME. Stun gun injury: a new presentation of the battered child syndrome. Pediatrics. 1992; 89:898–901.
32. Kocher MS, Kasser JR. Orthopaedic aspects of child abuse. J Am Acad Orthop Surg. 2000; 8:10–20.
33. King J, Diefendorf D, Apthorp J, Negrete VF, Carlson M. Analysis of 429 fractures in 189 battered children. J Pediatr Orthop. 1988; 8:585–589.
34. Friedman EM. Caustic ingestions and foreign body aspirations: an overlooked form of child abuse. Ann Otol Rhinol Laryngol. 1987; 96:709–712.
35. Dine MS, McGovern ME. Intentional poisoning of children an overlooked category of child abuse: report of seven cases and review of the literature. Pediatrics. 1982; 70:32–35.
36. Cohle SD, Trestrail JD 3rd, Graham MA, Oxley DW, Walp B, Jachimczyk J. Fatal pepper aspiration. Am J Dis Child. 1988; 142:633–636.
37. Arieff AI, Kronlund BA. Fatal child abuse by forced water intoxication. Pediatrics. 1999; 103:1292–1295.
38. Cameron CM, Lazoritz S, Calhoun AD. Blunt abdominal injury: simultaneously occurring liver and pancreatic injury in child abuse. Pediatr Emerg Care. 1997; 13:334–336.
39. Arieff AI, Kronlund BA. Fatal child abuse by forced water intoxication. Pediatrics. 1999; 103:1292–1295.
40. Schwengel D, Ludwig S. Rhabdomyolysis and myoglobinuria as manifestations of child abuse. Pediatr Emerg Care. 1985; 1:194–197.
41. Mukherji SK, Siegel MJ. Rhabdomyolysis and renal failure in child abuse. AJR Am J Roentgenol. 1987; 148:1203–1204.
42. Ward MM. Factors predictive of acute renal failure in rhabdomyolysis. Arch Intern Med. 1988; 148:1553–1557.
43. Grossman RA, Hamilton RW, Morse BM, Penn AS, Goldbery M. Nontraumatic rhabdomyolysis and acute renal failure. N Engl J Med. 1974; 291:807–811.
44. Diagnostic imaging of child abuse. Pediatrics. 2000; 105:1345–1348.
45. Ablin DS, Sane SM. Non?accidental injury: confusion with temporary brittle bone disease and mild osteogenesis imperfecta. Pediatr Radiol. 1997; 27:111–113.
46. Merten DF, Radkowski MA, Leonidas JC. The abused child: a radiological reappraisal. Radiology. 1983; 146:377–381.
47. Ball WS Jr. Nonaccidental craniocerebral trauma (child abuse): MR imaging. Radiology. 1989; 173:609–610.
48. Sinal SH, Ball MR. Head trauma due to child abuse: serial computerized tomography in diagnosis and management. South Med J. 1987; 80:1505–1512.
49. Rubin DM, Christian CW, Bilaniuk LT, Zazyczny KA, Durbin DR. Occult head injury in high-risk abused children. Pediatrics. 2003; 111:1382–1386.
50. Datta S, Stoodley N, Jayawant S, Renowden S, Kemp A. Neuroradiological aspects of subdural haemorrhages. Arch Dis Child. 2005; 90:947–951.
51. Feldman KW, Bethel R, Shugerman RP, Grossman DC. The cause of infant and toddler subdural hemorrhage: a prospective study. Pediatrics. 2001; 108:636–646.
52. Dias MS, Backstrom J, Falk M, Li V. Serial radiography in the infant shaken impact syndrome. Pediatr Neurosurg. 1998; 29:77–85.
53. Chapman S. The radiological dating of injuries. Arch Dis Child. 1992; 67:1063–1065.
54. Atwal GS, Rutty GN, Carter N, Green MA. Bruising in non? accidental head injured children; a retrospective study of the prevalence, distribution and pathological associations in 24 cases. Forensic Sci Int. 1998; 96:215–230.
55. Sivit CJ, Taylor GA, Eichelberger MR. Visceral injury in battered children: a changing perspective. Radiology. 1989; 173:659–661.
56. Anilkumar A, Fender LJ, Broderick NJ, Somers JM, Halliday KE. The role of the follow?up chest radiograph in suspected non?accidental injury. Pediatr Radiol. 2006; 36:216–218.
57. Kocher MS, Kasser JR. Orthopaedic aspects of child abuse. J Am Acad Orthop Surg. 2000; 8:10–20.
58. Morzaria S, Walton JM, MacMillan A. Inflicted esophageal perforation. J Pediatr Surg. 1998; 33:871–873.
59. Beckmann KR, Nozicka CA. Small bowel perforation: an unusual presentation for child abuse. J Am Osteopath Assoc. 2000; 100:496–497.
Table 1.
Laboratory tests indicated by specific clinical circumstances.
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