Child Abuse

Physical child abuse is defined as the nonaccidental injury of a child, ranging from minor bruises and lacerations to severe head trauma and death. It is estimated that 1 million children in the United States are seriously abused by parents or caretakers; approximately 125,000 of these involve physical abuse, i.e., nonaccidental injury, and between 2000 and 5000 deaths annually are attributed to child abuse. Evidence has shown that without intervention 50% of abused children will suffer some escalation of the violence. Although few injuries are pathognomonic for abuse, certain patterns of injury have begun to be associated with nonaccidental injury. Many of these injury patterns are apparent radiographically. Because of the increase in awareness of this important medical issue, with most states mandating reporting of suspected abuse, many institutions have developed interdisciplinary teams to investigate and manage suspected cases. Histories that are inadequate or inconsistent with the injury pattern should raise suspicion. Commonly acknowledged risk factors for abuse include premature birth, neonatal hospitalization, or other circumstance that might interfere with normal parent-infant bonding; adolescent parents; children with a congenital abnormality or special needs; and irritability and colic.

Causes

• Child abuse may occur when parents insist to children for particular work. Stress may also be caused by unemployment, financial problems, divorce and separation.
• Child abuse also occur, when parents under stress sometimes transfer their feelings of frustration onto their children.
• Child abuse can be caused by parents who have poor parenting skills.
• Main cause of child abuse is Frustration.

Symptoms

• Irritability
• "Clinging"
• Crying
• Poor feeding
• Inability or reluctance to engage with parent or other adult
• Immediate engagement with strangers

Signs

• Bruises +++; combining all age groups, this is the most common sign.
• Welts
• Burns ++; look for small, circular cigarette bums to palms and soles, stocking-glove distribution of immersion burns, geometric shapes from application of electric appliances, linear marks or bruises from belts or cords, and nonhealed injuries of different ages
• Fractures ++; over half of fractures may be nonaccidental in infants less than 1 year of age. Although not pathognomonic, the following fractures are highly suspicious for abuse: femoral, nonsupracondylar humeral, metaphyseal or "bucket­handle," rib (++, with 90% of these occurring in infants less than age 2), and diaphyseal in conjunction with concurrent skeletal or extraskeletal injury.
• Head injury +++; (majority in those <2 years). Seizures, lethargy, and decreased level of consciousness can be signs of intracranial trauma. Subdural hematoma may be precipitated by violent shaking or blunt trauma.
• Retinal hemorrhages (in most severely shaken infants); concurrent intracranial and skeletal injury has higher specificity for abuse.
• Abdominal injuries (3%, with the majority occurring at age >2 years); signs include bruises on the abdominal wall or manifestations of solid or hollow organ injury.
• Sexual abuse: blood or discharge noted in underwear, bruising on perineum, horizontal diameter of vaginal opening exceeding 4 mm, evidence of a sexually transmitted disease, recurrent UTIs, difficulty walking or sitting
• Signs of child neglect include malnutrition and poor hygiene.

Treatment

Counseling such as including play therapy, It is also necessary for abused children over age 2. Failure to help the child deal with the fear and pain resulting from abuse by adults, who should be trusted figures, can lead to significant psychological problems, such as post traumatic stress disorder (PTSD).