The cutaneous manifestations and common mimickers of physical child abuse.

The cutaneous manifestations of physical child abuse are some of the most common and easily recognized forms of injury. To make an accurate assessment and diagnosis, it is important to differentiate between inflicted cutaneous injuries and mimickers of physical abuse. Likewise, an understanding of reporting guidelines helps guide practitioners in their decision making.     

Current pediatric roles in child abuse and neglect.

Many pediatricians are being called on to undertake expanded roles in the field of child abuse and neglect, whether as a practicing pediatrician, a hospital-based child abuse consultant, or as a child protection team pediatrician. The practicing pediatrician must consider the diagnosis of child abuse and neglect, confirm the diagnosis, report all suspected cases to child protective services, hospitalize any abused child who needs protection, and provide preventive services. The hospital-based child abuse consultant should provide consultation to primary physicians, report seriously injured cases for the primary physician or surgeon, provide expert medical testimony on difficult to prove cases, teach house staff and medical students about child abuse and neglect, and improve treatment services for abused children who are hospitalized. The child protection team pediatrician will usually become involved in the broader problem of improving team decision making and the interagency system that deals with child abuse and neglect.     

Burns as a manifestation of child abuse and neglect.

A multidisciplinary child abuse team investigated children with burns admitted to a general hospital in Tulsa, Okla. Of the 26 burn cases investigated, 14 were found to be accidental, seven accidental with extreme degrees of neglect, and five nonaccidental burns. There are correlations between physical findings and social characteristics, which may aid in the identification and disposition of children with burns. A multiplicity of injuries suggests that nonaccidental burns are not spontaneous abuse, but a planned form of aggression. The high mortality of the abused group indicates the seriousness and severity of nonaccidental injuries. This experience has also shown that nonaccidental burns in children demand a thorough investigation of medical, social, and emotional factors.     

Professional education in child abuse and neglect

Physicians have reported feeling that they were not adequately trained to identify and report child abuse. This article reviews the current state of medical education and residency training and the needs of physicians in practice and proposes changes and additions that can be made to improve the ability and confidence of physicians who are faced with the responsibility of keeping children safe.     

An update on child abuse and neglect

PURPOSE OF REVIEW: Nonaccidental trauma and neglect continue to be major problems for children, families, and the providers who care for them. Whereas prevention is the key to ending child abuse and neglect, diagnosis and treatment continue to be the mainstays of practice. This article will briefly review the epidemiology, diagnosis, sequelae, and prevention of abuse and neglect in today's world. RECENT FINDINGS: The latest statistics estimate that more than 900000 children are victims of child maltreatment. Abuse occurs at all ages but is most common in younger children. Child abuse may manifest as skin injuries, skeletal trauma, head injury, or many other forms. Information on abusive head trauma has been published in large amounts in the past year and is reviewed in further depth. The long-term consequences, the keys to prevention, and the role for pediatric providers are also reviewed. SUMMARY: Whereas great strides have been made in diagnosing and treating child abuse, our work has been cut out for us in preventing child abuse. Pediatric clinicians must continue to screen patients and families, recognize signs and symptoms of abuse and neglect, and find time to advocate for home visits, early intervention programs, and education on this very important topic.     

Partial recovery from severe child neglect and abuse

A 3-year-old boy and his 9-month old sister received developmental assessments 2 weeks after removal from a neglectful and abusive family. The children were evaluated for a second time 5 months after removal, after spending the interval together in a foster care setting. They received no specialized services geared toward stimulating their development. Significant impairments in growth, cognition, adaptive skills, and language noted during the initial assessment were not as evident at followup. The developmental profiles, however, were not normal. The largest gains were in adaptive skills. Expressive language skills remained relatively impaired. It appears that significant developmental gains can occur in developmentally impaired children who are removed from an abusive and neglectful home and placed in foster care for several months.     

Oral and dental aspects of child abuse and neglect

In all 50 states, physicians and dentists are required to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this report is to review the oral and dental aspects of physical and sexual abuse and dental neglect and the role of physicians and dentists in evaluating such conditions. This report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, and diseases that may cause suspicion for child abuse or neglect. Physicians receive minimal training in oral health and dental injury and disease and, thus, may not detect dental aspects of abuse or neglect as readily as they do child abuse and neglect involving other areas of the body. Therefore, physicians and dentists are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions.     

Demographic and clinical features of child abuse and neglect cases

The aim of this study was to present child abuse and neglect (CAN) cases of the Child and Adolescent Psychiatry Department of Hacettepe University Faculty of Medicine. The charts of all the patients seen at the Child and Adolescent Psychiatry Clinic between 2000 and 2004 were screened regarding the presence of CAN. The mean age of the children was 10.9 years. The offender was generally an extra-familial acquaintance (40.7%). The most common type of abuse was sexual (77.8%) and the most common associated types of abuse were physical and sexual (7.4%). Attention deficit hyperactivity disorder (ADHD) was observed as the most common psychiatric diagnosis (22.2%). Abuse types in relation to age and gender of abused child, risk factors and associated psychopathologies are discussed. Issues related to legislative process and ecology of the abuse experience are mentioned as restrictions for the prevention and treatment of CAN.     

Rhabdomyolysis and myoglobinuria as manifestations of child abuse

Rhabdomyolysis should be suspected in cases of physical child abuse in which there is extensive soft tissue injury. It is easily investigated using the urinalysis and serum CPK levels. Renal failure is the most common complication and manifests itself as acute tubular necrosis, sometimes accompanied by the following specific laboratory abnormalities: elevated creatinine-to-BUN ratio, hyperkalemia, and myoglobinuria. Treatment is aimed at the preservation of renal function and the prevention of complications caused by electrolyte abnormalities. A full recovery can be expected for adults with this disorder, but information about the pediatric population is sparse. Our series suggests rapid improvement with appropriate therapy.