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Non-Accidental Injury (Child Abuse) |
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Recognition: 1. Inexplicable delay between injury and medical attention 2. Obvious discrepancy between the nature of the injuries and the explanation offered 3. Repeated injuries
Bruising Seen in 90% of abused children, usually as a number of bruises at different stages of healing. Normally bruising is rare in young children. Orofacial bruising may be seen on the scalp, forehead, cheeks, behind ears or around the neck. These are not commonly bruised areas from normal childhood play.
Beating The pattern of inflicted beating may be recognised as: ¨ Multiple linear marks or bizarre marks ¨ Buckle or belt marks ¨ Hand marks ¨ Marks left by whips, chains, ropes
Knife wounds Cuts or lacerations may be noted on the forehead or face. These have sometimes been associated with ritual significance. The explanations given by the carers or parents may not fit the pattern of injury.
Burns Burns are the result of dry heat. Look for: ¨ Cigarette burns—circular 0.5—1cm ¨ Contact burn—shape conforms to object ¨ Friction burns—superficial, often over points of contact (shoulders, forehead, knees)
Scalds Scalds are the result of wet heat. Look out for: ¨ Accidental scalds, with splash marks ¨ Clear demarcated scalds, which imply dipping
Orofacial injuries ¨ Lips—bruising and laceration ¨ Mucosa—torn fraenum ¨ Tongue—scarring or deviated from previous trauma ¨ Teeth—discoloured and fractured, or knocked out ¨ Occlusion—deranged
Facial bone fractures In children, fractures of the mandibular condyles are uncommon. A blow to the lower jaw can give rise to unilateral or bilateral condylar fractures. Assess mandibular movements and take an OPG.
Facial stare This is seen in victims of NAI and was described by Speight, 1989, as ‘a vacant facial stare’. The child switches off from the events around him in an attempt to try and avoid attention and abuse. The child does not respond, or responds very slowly. It is characteristic of repeated abuse—physical, verbal or emotional. |
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Four Categories of Abuse: Neglect, Emotional, Physical, Sexual |
