| Definition: |
Refers to children who have undergone physical abuse that has left them with both physical and psychological trauma.
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| Alternative Names: |
Non-accidental trauma (NAT); Child abuse
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| Causes, incidence, and risk factors: |
| Physical abuse of children occurs throughout every social strata, although there may be an increased incidence among those living in poverty. Abuse often occurs at moments of great stress, and the perpetrator strikes out in anger at the child. The perpetrator may also have been abused as a child and may have poor impulse control. Because of the relative size and strength difference between adults and children, the abused child can be severely injured or killed. Abuse frequently occurs from shaking an infant, which causes bleeding over the brain (subdural hematoma) and is often referred to as 'shaken baby syndrome'. The incidence of child abuse is remarkably high and fairly accurately reported. The total abuse rate is 25.2 per 1000 children with physical abuse counting for 5.7 per 1000, sexual abuse 2.5 per 1000, emotional abuse 3.4 per 1000 and neglect accounting for the vast majority 15.9 per 1000 children. Risk factors include poverty, lack of education, single parenthood, alcohol or drug abuse and a host of other factors. However, child abuse occurs in all strata of society.
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| Symptoms: |
- appearance at an emergency room with an injured child and an improbable explanation
- delayed appearance at an emergency room with an injured child
- bruise marks shaped like hands, fingers, or objects (belt)
- specific patterns of scalding seen when a conscious child is immersed in hot water
- burns from an electric stove, radiator, heater or other hot objects on the child's hands or buttocks
- cigarette burns on exposed areas or the genitals
- black eyes in an infant
- human bite marks
- lash marks
- choke marks around neck
- circular marks around wrists or ankles (twisting)
- sutures - separated
- bulging soft spot (fontanel) on the infants head
- unexplained unconsciousness in infant
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| Signs and tests: |
Physical examination may show other injuries, such as:
- multiple retinal hemorrhages (bleeding in the back of the eye)
- internal damage such as bleeding or rupture of an organ from blunt trauma
- any fracture in an infant that is too young to walk or crawl
- evidence of epiphyseal fractures (often multiple) of long bones or spiral type fractures that result from twisting
- fractured ribs
- evidence of skull fracture(s) (occasionally multiple fractures of different ages may be present)
- subdural hematoma (collection of blood in the brain) without plausible explanation
Tests that reveal physical injuries include:
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| Treatment: |
Physical injuries are treated as appropriate for the specific injury. Counseling or intervention of some type for the parent(s) is mandatory. Life threatening abuse or abuse resulting in permanent damage to the infant or child may result in incarceration for the perpetrator. In some cases, the child may be temporarily or permanently removed from further danger.
Many states require that known or suspected child abuse be reported to the police, and reporting is automatic. Child protection services are also notified. The disposition of the child will be determined by the severity of the abuse, the likelihood of recurrence, and other factors. Decisions regarding placement or returning to the home usually are made by the Child Protective Agency through the court system. |
| Expectations (prognosis): |
| The child's recovery depends on the severity of the injuries, and the outcome of the family or abuser rests with the authorities. The child protective services generally make every effort to reunite families whenever possible. |
| Complications: |
| Physical abuse of a child can lead to severe brain damage, disfigurement, blindness, crippling, and death. Abused individuals may carry emotional scars for a lifetime. Children can be removed permanently from the parents' custody if the parents are the perpetrators and the cause is sufficient to warrant termination of parental rights. |
| Calling your health care provider: |
| Call your health care provider or protective services if you suspect or know that someone is being abused. |
| Prevention: |
Recognition of pending abuse can help prevent actual abuse. Warning signs are:
- a previous abuse history (previous abuse of the child or the child's siblings)
- lack of apparent parental love or concern
- failure to maintain the child's proper hygiene or care
- parental alcohol or drug problems
- parental emotional problems or mental illness
- a history of abuse in the parent's childhood
- high stress factors in the family life
Intervention with counseling when any of these factors are present may prevent abuse. Watchful guidance and support from the extended family, friends, clergy or other supportive persons or groups may prevent abuse or at least lead to early intervention in cases of abuse. |
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Review Date: 8/15/2001
Reviewed By: Elizabeth Hait, M.D., Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH. Review provided by VeriMed Healthcare Network.
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