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.
Reviewed By: Rachel A. Lewis, MD, FAAP, Columbia University Pediatric Faculty Practice, New York, NY. Review provided by VeriMed Healthcare Network.
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