Physical Abuse of Children

Circumstances of injury in children with abusive versus non-abusive injuries

BACKGROUND

Although previous studies have examined differences in the characteristics of abusive versus non-abusive injuries, no study has focused on the differences in the circumstances surrounding these injuries, such as whether the event that caused the injury was witnessed or heard, or EMS was called.

OBJECTIVE

To determine predictors related to the circumstances of the injury (COI) for distinguishing abusive versus non-abusive injuries.

PARTICIPANTS/SETTING

Children younger than 3-years-old who were hospitalized with either a head injury or a fracture and evaluated by the child abuse consultation service between June 1, 2008 and June 30, 2017.

METHODS

In this case-control study, abusive (cases) and non-abusive (controls) injuries were determined by a consensus of two experts blinded to the COI. Multivariable logistic regression was used to identify COI predictors of abusive injuries.

RESULTS

We identified 302 children: 80 cases (26.5%) and 222 controls (73.5%). Abused children were less likely to have a clear event described (p < .001). Of the 251 with a clear event, we found that the significant variables for abuse were father's presence (adjusted odds ratio [aOR] 8.37; 95% CI 3.35-20.92), delay ≥24 h in seeking care (aOR 6.23; 95% CI 1.95-19.92) and calling EMS (aOR 3.21; 95% CI 1.10-9.36). In contrast, the event being heard (aOR 0.22; 95% CI 0.08-0.0.59) and the child being dropped (aOR 0.09; 95% CI 0.01-0.77) were less likely to be abusive.

CONCLUSION

We identified five COI predictors that may help clinicians in determining whether a child's injuries are due to abuse.

Digital dermatoses: skin disorders engendered by social media in tweens and teens

PURPOSE OF REVIEW

Photograph-based social media use among children and adolescents has skyrocketed over the past decade, raising concerns about the implications for self-confidence and behavior in this population. Social media 'challenges' encourage participants to complete potentially dangerous tasks while sharing their completion of the tasks on social media. Many of these challenges affect the skin and lead to recognizable findings on physical examination. This review discusses the history of prominent social media challenges and their effects on the skin. Attention is also given to the effects of social media trends on self-confidence and body image in children and adolescents.

RECENT FINDINGS

Over the past several years, there have been several notable social media trends that can harm the skin. These include the Kylie Jenner lip challenge, salt and ice challenge, deodorant challenge, eraser challenge, fire challenge, and hot water challenge. Participation in these challenges can cause morbidity in children and adolescent that should be recognized by clinicians.

SUMMARY

Social media has become an important platform for communication and self-expression among children and adolescents. Pediatricians should remain aware of social trends in this age group and look out for cutaneous findings that may signal dangerous behavior on social media.

A qualitative description of how Ghanaian radiographers identify suspected child physical abuse

INTRODUCTION

Child physical abuse is intentionally inflicted injury of a child and presents a challenging diagnosis to clinicians mostly as a result of doubts about whether the findings were perpetrated by carers of these children. Suspected child physical abuse cannot be reported without its initial identification, substantiation and reporting. Imaging findings is one way of providing evidence of abuse in court.

METHODS

A qualitative design was used to gather data. Twenty (20) radiographers were recruited using purposive criterion sampling to share their experiences of mode of identification of suspected child physical abuse. Semi-structured interviews were conducted to gain deeper insight into their experiences.

RESULTS

Radiographers' suspicion or identification of child physical abuse was based on four (4) constructs: pre-radiographic observation; child's physical signs; caregiver secrecy and imaging findings. These observations provoked further investigations through questioning of the child (if of verbal age), parent or both. Their initial suspicion through assessment of cases was sometimes strengthened by the imaging findings.

CONCLUSION

Radiographers suspected child physical abuse using several approaches some of which were found to be unacceptable although it led to other important information, such as additional imaging performed by the radiographers without doctor consultation. However, being able to identify child physical abuse is important in child protection activities.

IMPLICATION FOR PRACTICE

Identification and reporting of suspected abuse to the appropriate child protection authorities are imperative for child protection. The possibility that some experienced radiographers may fail to deal with serious instances of child abuse exist. A radiographer's inability to identify such cases, could that the victim would miss the required protection from the professional.

Pancreatic Laceration in a Pediatric Patient: An Unexpected Diagnosis

Pediatric pancreatic injuries are rare. We present an atypical case that occurred in a 4-year-old male. The child presented with a twenty-four-hour history of vomiting that had progressed to right lower quadrant abdominal pain on examination in the emergency department. The initial differential was gastroenteritis versus appendicitis. An abnormality on the ultrasonography and an elevated lipase level eventually led to an MRI showing a complete transection through the posterior margin of the pancreas. The patient was admitted to pediatric surgery and underwent a successful distal pancreatectomy with preservation of the spleen. On further inquiry specific to trauma, the child disclosed that his older brother had punched him in his abdomen the night before. The child's parents were separated due to intimate partner violence, and this older sibling recently had been very stressed. The sibling was referred for mental health evaluation and counseling, and the case reported to the county children and youth investigative services system. A low threshold for considering trauma and child abuse in the pediatric population is recommended when significant intra-abdominal injury is diagnosed.

Recognizing Maltreatment in Children with Special Needs

Children with special needs are at a greater risk of maltreatment than other children. Understanding risk factors unique to this population will help the pediatrician determine which children are at risk, make the physician aware of what to assess in the office setting, and provide education to the child, family, and caregivers to prevent maltreatment. [Pediatr Ann. 2016;45(8):e273-e277.].