CHILD ABUSE
CHILD ABUSE
• is also known as "the battered
baby" or "non-accidental injury
in childhood" (NAI) or syndrome
of child abuse and neglect
(SCAN).
WHO DEFINITIONS
ALL forms of physical, emotional, sexual, and
neglect that results in actual or potential
harm to the child’s health, survival,
development or dignity.
DEFINITION of physical child
abuse
Non accidental repetitive physical injuries
including minimal as well as fatal injuries
inflicting upon infants or children by persons
caring for them
CLASSIFICATION OF
CHILD ABUSE
PHYSICAL ABUSE
CHILD NEGLECT
SEXUAL ABUSE
EMOTIONAL ABUSE
Parental Child
Environmental
a) Personal Criteria and Psychological
Condition of the Parents
-low self esteem.
-unstable emotional and mental problem
-depression and anxiety
- Stressful life.
b) Parents History of Abuse and the Cycle of Abuse
-1/3 of parents who abuse their child was previously abused by
their parents.
c) Age of Parents
Young parents 15 to 20 years
old
d) Attitude and
Knowledge
Inadequate and inaccurate
knowledge about the child
development
e) Substance Abuse of
the Parents
-alcoholic
-drug abuser
DISABILITIES OTHERS
AGE
- Congenital - Unwanted child
- Under 5:
anomalies - Difficult feeding
physically abuse
- Physically - Naughty
- Teenagers:
handicapped - Aggressive
sexually abuse
- Mentally retarded - Attention deficit
POVERTY AND
UNEMPLOYMENT
SOCIAL ISOLATION
-no social support
VIOLENCE
COMMUNITIES
CHILD NEGLECT
Failure by parents or caregiver to provide a
child for their physical and emotional
needs for development and wellbeing.
Physical neglect Educational neglect
Environmental
Emotional neglect
neglect
EMOTIONAL ABUSE
Persistent inappropriate verbal or symbolic acts
toward a child which affect the child’s behaviour
and development.
WITNESSING OF FAMILY ABUSE
Children being exposed to domestic violence
between intimate partners.
Child being present (hearing or
seeing) while parent or sibling is
subjected to physical, sexual, mental
abuse
Visually exposed to damage
MEDICOLEGAL
INVESTIGATIONS OF A CASE
OF CHILD ABUSE
Characteristic history
• Unexplained delay in reporting injuries or seeking
treatment
• Presenting symptoms and history are changed after
initial presentation
• Discrepancy in the stories given by each parent or
caregiver separately
• Discrepancy between the history and the physical
finding
• Injuries blamed upon a sibling or another child
CHARACTERISTIC SIGNS
General signs highly suggestive of child abuse
B.Physical abuse - Unexplained injuries e.g.,
bruises, burns or cut
- Different type of injuries e.g.
fractures together with burns - The suspected lesions are
of different kinds covered by sticking plasters
or clothes
- Multiple lesions of different
ages
- Multiple lesion from a
single cause e.g., 2 separate
cigarette burns
- Unusual soft tissue injuries
e.g. avulsion of frenulum of
the lips
Emotional abuse
- The child may be alert or
apathetic or in excessive
fear
- Anxious about doing
something wrong
- Extremes in behavior
- Depression or stress
- Lack of attachment with
the parent/caregiver
C.Child neglect D. Sexual abuse
- The suspected constant hunger, - Trouble walking or sitting
sometimes stealing food from
- Starting to wet at bed and
other children
having nightmare
- Wear inappropriate clothing
- Doesn’t want to change
- Consistently bad hygiene or smelly
clothes in front of others
- Left alone in unsafe environment
- Lustful act and seductive
- Loss of weight, or being constantly
underweight
behavior
- Untreated illness any physical - Medical conditions like STDs
injuries or pregnancy
SCLAP INJURIES
Scalp bruises are easily felt.
SCALP LACERATION
SCALP BRUISE (CUT WOUND)
TRAUMATIC ALOPECIA
SKULL FRACTURES
• The most common
fractures lie in the
occipito-parietal area.
The parietal bone may
dimple inwards without
fracture leading to brain
damage in the absence of • Skull fractures are
fracture. often associated
with subdural
• Suture diastases may hemorrhage.
occur with or without
fractures.
SHAKEN BABY SYNDROME (Caffeys' Syndrome)
• It is characterized by retinal, subdural
± subarachnoid hemorrhages and
acute encephalopathy plus no
additional signs of contact to the skull
or brain .
It may be associated with shaking the baby
violently or with an extreme blow to the
head, such as occurs when children are
thrown against a hard object.
It is a form of child abuse that can result in
permanent brain damage or death.
The chest is compressed resulting in rib
fractures.
Arms and legs move in a whiplash
movement resulting in the typical 'corner'
or 'bucket-handle'-fractures in the
metaphyseal region
Bucket handle fracture in
proximal tibia
FACE INJURIES
Fingertips bruises on the sides of the cheek across the mouth to stop the child
crying.
Teeth: Loosening, breakage even total avulsion of teeth from the sockets.
SLAPPING MARKS
BURNS
BRUISES AND PETECHIAE
BLACK EYE ( RACCOON EYE)
-conjunctival
hemorrhages
-scleral hemorrhages
-vitreous hemorrhage
-retina hemorrhage
-lens dislocation
EAR INJURIES
POST AURICULAR ,EXTERNAL EAR BITE MARK
BRUISING
FINGERNAIL PRINTS
bruising and petechiae over the occipito-
parietal
scalp
MOUTH INJURIES
Fractured teeth as a result of a
backhand blow to the face.
Trauma from a direct blow
to the child's mouth.
Torn Frenulum
is pathognomonic sign
of deliberate child
abuse.
Tongue laceration -- note that this child had no teeth that
could have caused this.
NECK INJURIES
STRANGULATION MARK
Ligature mark
BURN ON SIDE OF THE NECK
STRANGULATION MARK
CHEST INJURIES
healing rib fractures with callus
formation that gives string beaded
Skin of chest showing 'belt- appearance in X-ray
mark' and bruises
They are not evidence on X-ray in acute
stage,as little displacement occurs.
INTERNAL ORGAN INJURIES
The mortality rate is 50% due to
“patients and doctors delay”.
Children are brought to hospital
days after the injury, when
perforation has already resulted in
peritonitis and sepsis
Common abdominal injuries in
Pancreatic laceration
abused children are:
Liver and pancreas: hemorrhage
and laceration
Stomach: traumatic rupture
Small intestine: bowel ruptures,
especially duodenum.
These are produced by
compression or kneeling on the
child. Liver laceration
LIMBS INJURIES
A. Bruises around the joints
from gripping in order to
swing or shake the
infants.
B. Fractures at any site in
diaphysis, may be (A)
multiple.
C. Spiral fractures indicate
twisting injury.
D. Avulsion of parts of
metaphysis and slipped
epiphysis are causes by
traction.
(C) (D)
Callus = fracture healing
BITES
• adult bite on a child is the only
physical injury where there is the
potential to identify exactly who
has attacked the child
• We must differentiate between
abuser bites, other children bites
and self-inflicted bites:
a. Favorite sites: arms, back of
hands, cheeks, shoulders and
buttocks.
b. Shape: consists of two
opposing semicircles with
abrasion, contusion or both.
c. Size: size of dental arch
determines whether it is done
by an adult, child, or animal.
Type of Burns
Dry burns Scalds
• Unlikely sites such as • Hot water
buttock and perineum • Dipping in hot liquid
• Ciggarettes burns • Scald burns may be either a
spill/splash type of burn or
an immersion burn, the
most common of the liquid
burn injuries.
Accidental burns Non-Accidental burns
• Reasonable story • Changing or unclear story
• Irregular burn margins • Sharply demarcated burn
• Variable burn depths margins
• Multiple splash marks; burn • Uniform burn depth / Full
• lessens in severity as liquid thickness
flows down body • No splash marks
• Initial point of contact deeply • Creases & opposing skin surfaces
burned spared
• Geometric pattern or object
imprint, (iron, cigarette lighter)
• Larger burns
Accidental scalds are frequently caused by spillages of hot
liquid in food preparation and are found on the head, neck,
trunk, face and upper body from the ‘pull down mechanism’.
Characters: irregular margins, an irregular burn depth and
asymmetrical involvement.
Intentional burns
18-month-old washing his hands
sharp demarcated lines,
uniform depth,
no splash marks,
circumferential pattern
Glove pattern
7 y sibling give the baby a bath
Classic immersion burn
