2. INTRODUCTION
Defines child abuse and neglect as:
• Death
• Imminent risk of serious harm
• Serious physical or emotional harm
• Sexual abuse
• Exploitation
4/2/2024
2
3. TYPES OF INJURY
4 Types of abuse
–Physical abuse
Harming a child with or without intention of injury
–Neglect
Failing to provide a child’s basic needs
Physical, medical, educational and emotional
–Sexual abuse
–Emotional abuse
4/2/2024
3
4. EPIDERMIOLOGY
Difficult to determine prevalence and track trends
Inconsistencies in reporting variation in definitions
•The number of children who received child protective services
(CPS) investigation increased 8.4% from 2014 to 2018.
•In 2018, 4.3 million referrals to CPS7.8 million children
• 678,000 known cases
• 1,770 deaths
4/2/2024
4
6. PHYSICAL ABUSE
Among infants and young children represent 12-20% of
fractures
• Fractures are 2nd most common presentation of physical
abuse.
• Found in 25-50% of cases.
• ~20% involve burns
• The youngest patients are most affected and vulnerable
Unable to report
<1 year MUCH higher rate of abuse
4/2/2024
6
7. RISK FACTORS
CHILD FACTORS
1. Young(age<3yr)
2. First born children
3. Unplanned children
4. Premature infants
5. Disabled children
6. Psychosocial comorbidities
7. Stepchildren
8. Single-parent homes
PARENTAL FACTORS
1. Substance abuse
–50-80% involve some
Degree of substance abuse
2. Families with low income
3. Unemployed parents
4. Children of parents with
psychosocial comorbidities
5. Children of parents who were
abused
4/2/2024
7
8. GENERAL PRESENTATION OF CHILDREN WITH NONACCIDENTAL
TRAUMA
Bruise
Burns
Fracture
Abusive head trauma (AHT) (shaken baby syndrome)
Epidural haemorrhages, subdural haemorrhages, subarachnoid haemorrhages, skull
fractures,
Ocular manifestations
Periorbital hematoma, eyelid laceration, subconjunctival haemorrhage, subluxate or
dislocated lens, cataracts, glaucoma, anterior chamber angle regression, iridiodialysis,
retinal dialysis or detachment, intraocular haemorrhage, optic atrophy or papilledema
4/2/2024
8
10. HISTORY
• Age of Patient
1. 3>yrs.
• History
1. Has there been a delay in seeking medical treatment?
2. Is the parent reluctant to give an explanation?
3. Is the injury consistent with the explanation given?
4. Does the story change?
5. The abused child maybe overly compliant and passive or extremely aggressive
6. Is the affect appropriate between the child and the parents?
• Social situation
1. Families under stress (loss of job, etc.)?
2. Drug oral or alcohol abuse?
3. Parents in abusive relationships
4. Poor compliance with past medical treatment
4/2/2024
10
11. PHYSICAL EXAMINATION
Careful search for signs of acute or chronic
trauma
• Skin-bruises, abrasions, burns
• Head- examine for skull trauma, palpate,
fontanelles if open, consider funduscopic exam
for retinal haemorrhage
• Trunk-palpate ribcage, abdomen
• Gentalia – bruises, abrasions, oedema
• Extremities-careful palpation
4/2/2024
11
12. INVESTIGATIONS
1. Laboratory Investigation
FBC, CRP, ESR, FULL BLOOD COUNT, COAGULATION PROFILE
2. Skeletal survey
BONE SCAN, BONE XRAYS,
3. Intracranial Survey
EEG, CT SCAN, MRI, HEAD XRAY
4. Ophthalmologic examination
FUNDOSCOPIC EXAM
5. Abdominal CT Scan
4/2/2024
12
13. EVALUATION
Imaging
• Skeletal survey for children with suspicion of NAT Highly detailed radiographs that follow
guidelines set for by the American College of Radiology are necessary.
• AP/LAT skull
• AP/LAT axial skeleton and trunk
• AP bilateral arms, forearms, hands, thighs, legs, feet.
Specificity of Radiologic Findings in NAT
High Specificity: Metaphyseal corner lesions, posterior rib fractures, scapular fractures,
spinous process fractures, sternal fractures.
Moderate Specificity: Multiple fractures, fractures of different ages, epiphyseal separations,
vertebral body fractures, digital fractures, complex skull fractures
Common in NAT but Low Specificity: Clavicular fractures, long bone shaft fractures, linear
skull fractures
4/2/2024
13
14. MANAGEMENT OF NAI
• Team approach Paediatrician
• ER physician
• Medical social worker
• Government child protection agencies
• Law enforcement
Treatment for any underlying pathology
Monitor treatment progress
Appropriate law enforcements measures and Counselling
4/2/2024
14
15. COMPLICATION
• EARLY COMPLICATION
o DEATH
o CEREBRAL INFARCTION
o CARDIORESPIRATORY ARREST
o STATUS EPILEPTICUS
oLATE COMPLICATIONS
o PERMANENT DISABILITY
o CEREBRAL PALSY
o PARALYSIS
o POST TRAUMA STRESS DISORDER
4/2/2024
15
16. REFERENCE
• AkbarniaBA,AkbarniaNO.Theroleoftheorthopedistinchildabuseandneglect.OrthopClinNorthAm1976;
7:733-42.
• KocherMS,KasserJR.Orthopaedicaspectsofchildabuse.JournaloftheAmericanAcademyofOrthopaedic
Surgeons2000;8 (1):10-20.
• KovlerML, Ziegfeld S, Ryan LM, Goldstein MA, Gardner R, Garcia AV, Nasr IW. Increased proportion
of physical child abuse injuries at a level I pediatric trauma center during the Covid-19 pandemic.
Child Abuse & Neglect. Online before print. 2020. 104756, ISSN 0145-2134,
https://doi.org/10.1016/j.chiabu.2020.104756.
• RanadeSC, Allen AK, Deutsch SA. The Role of the OrthopaedicSurgeon in the Identification and
Management of Nonaccidental Trauma. Journal of the American Academy of OrthopaedicSurgeons
2020;28(2): 52-65.
• Feldman KW, Bethel R, Shugerman RP, et al. The cause of infant and toddler subdural
hemorrhage: a prospective study. Pediatrics 2001;108:636-46.
• Section on Radiology, American Academy of Pediatrics. Diagnostic imaging of child abuse.
Pediatrics 2009;123:1430-5
• Hasbani DM, Topjian AA, Friess SH, et al. Nonconvulsive Electrographic Seizures are Common in
Children With Abusive Head Trauma. Pediatr Crit Care Med 2013;14:709-15.
4/2/2024
16
