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Child Abuse. Naminder Sandhu & Dr. Bela Sztukowski September 1, 2011. Video: Infant beat to death by father - PowerPoint PPT Presentation
Citation preview
Video: Infant beat to
death
by father
BATTLEFORD — A 25-year-old
Lloydminster man who “sn
apped” while
changing his infant so
n’s diaper, fa
tally
injuring the child, has received a priso
n
sentence of 5 1/2 years for
manslaughter.
APRIL 26, 2011
Toddler dies in hospital;
police to charge
Medicine Hat day home
worker
BY CALGARY HERALD, GLOBAL TV CALGARY
JULY 22, 2010
NEWS CANADABaby girl savagely beaten by woman before rescue CHRIS KITCHING, SUN MEDIA
FIRST POSTED: WEDNESDAY, SEPTEMBER 2,
2009
Objectives
• Identify suspicious injury patterns – Consider ddx and mimics
• Review appropriate investigations• Explore management options• Know your medical and legal responsibilities
Epidemiology
Canadian Incidence Study of Reported Child abuse and Neglect, 1998
•22 investigations/1000 children (2.2%) •45% of cases confirmed by child welfare workers (9.9 cases/1000)
Think twice if….
1) Sounds crazy but explains injury2) Sounds reasonable but doesn’t explain injury• 30 degrees out and “she ran bare feet
onto the hot pavement”… but arches of feet also burned!
General assessment• Behavioural indicators– Age appropriate? Regression?– Emotional attachments– School– Drugs – Mood, sleep– Trouble with law
• Physical indicators– Hygeine – Growth– Injuries
Which is not in ddx for SDH?
• Accidental short fall• Birth trauma • MVC• Minor or no trauma with F13 deficiency• Minor trauma with Marfan• Abusive head trauma• Other: Vit K defic, hemophilia A, vWD, platelet
function disorders, platelet number disorders, metabolic disorders (glutaric aciduria type 1)
Case 2
• 2 year old developmentally delayed tripped on rug and fell onto left side; cried right away, been grabbing ear since
Case 4
• 12 month old girl on shoulders of dad going down stairs when she lost balance and fell to the side and now not moving arm, swollen
Fractures from abuse• Non ambulatory child with fracture• Fracture from fall from bed/crib/couch• Strongly suggestive of:– Ribs– Long bone metaphyses– Scapula– Sternum– Vertebral spinous processes
• Moderately suggestive:– Multiple fractures– Fractures of different ages– Epiphyseal separation– Vertebral body fractures
Other signs of abuse
• Traction alopecia• Growth parameters• Extensive dental caries • Severe diaper dermatitis• Neglected wound care
Other injuriesVisceral abdominal•predominantly in children > 2 years old•2nd most common cause fatalities •usually blunt trauma (punch or kick to abdomen, rapid deceleration after being thrown)
Investigations
• American Academy of Pediatrics/ Canadian Pediatric society guidelines– Skeletal survey: < 2yo
• Consider repeat in 10 – 14 days
– Head CT– Ophthalmology consult– CBC, coags
– Bone scan?– Bone mineralization labs? Metabolic work up?
Social work always available in the ED
If concerned….. Call:•Child & Family Services: 297-2995•Child abuse service: Dr. Neil Cooper•Sexual abuse clinic: Dr. Jen MacPherson (outpatient referrals)
What to do at the ACH
Document document document
HPI:Mother states “… was washing the dishes when I heard a thud and I ran to the living room and saw her on the floor”…. “she had rolled off the couch”….
P/E:
Take home points• Child abuse is not always
obvious know what to ask and what to look for
• Always keep in mind mimickers
• Document carefully and objectively
• If any suspicion, report and investigate, and consider admission