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My father is a pediatric orthopedic surgeon. I am doing some research to help him learn more about how to recognize child abuse that isn't always so obvious. Can you help me out?
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Over three million young children are victims of child abuse in the United States each year. One-third of all child abuse cases will suffer a bone fracture and need to see an orthopedic surgeon. That's why orthopedic surgeons must be aware of the possibility of child abuse and watch for it. We applaud you in trying to help get this information into the hands of someone who can make a difference.
There was a recent nationally-based study done comparing children with accidental injuries to those with suspected or confirmed child abuse. By comparing various features of the children in both groups, the researchers were able to identify common features that suggest injuries from child-abuse.
This information may help all physicians (but especially orthopedic surgeons) know what to look for that might raise the suspicion of abuse. The strongest predictor of abuse is young age with two groups especially at risk: birth to one year and one year up to two years of age.
The second predictive factor was type or pattern of injury. Fractures affecting the bones of the head, neck, and trunk were most common. But fractures of the long bones of the arms and legs must be closely assessed, too. This includes the femur in the thigh, tibia or fibula of the lower leg, humerus of the upper arm, and radius or ulna of the forearm. The one area of fracture that proved to almost always be accidental was a pelvic fracture. More than even fractures, an important physical sign is a contusion. A contusion is a visible bruise or large black and blue mark.
The third predictive factor of abuse-related injury was the specific period of time when the injury took place. Weekdays and during the winter seemed to be a common pattern for child abuse. Weekends might be less stressful with more adult supervision available. Or possibly the attendance of church services influences behavior.
It was thought that perhaps with colder weather and being indoors more in the winter, children would be more likely to spend time with the caregivers who were the abusers. Being outside less during winter months might also lower the risk of accidental injuries making it seem like there are more cases of injuries from abuse than from accidents during the winter.
The researchers also looked at socioeconomic level to see if there was a link there. They couldn't use family income as a marker because it wasn't always reported. So they looked at who was paying for the medical charges. They found that more families on Medicaid than on private insurance were involved in child maltreatment. Medicaid suggests a lower family income.
It isn't always easy to tell when an injury is accidental or the result of child abuse. But physicians examining children with physical injuries must always keep the possibility of abuse in the back of their minds. Having a few guidelines like these can be helpful when looking for any clues to help in making the diagnosis.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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