Presentation MCHConf Smith IdentificationOfChildrenAtRisk Apr2016 PDF
Presentation MCHConf Smith IdentificationOfChildrenAtRisk Apr2016 PDF
Presentation MCHConf Smith IdentificationOfChildrenAtRisk Apr2016 PDF
Anne Smith
Medical Director, Victorian Forensic Paediatric Medical Service
10 key messages
Babies & toddlers are killed and are injured by abuse & neglect
Child abuse is easy to miss
Don’t guess
Act quickly & act wisely
Identification of children at risk
Forensic perspective
1. Psychosocial
• Interaction between adult(s) and child
• Caregiver capacity to parent
• Physical injury
• Emotional abuse
• Neglect
• Other (fabricated / induced illness/ SA)
• Adverse outcomes – life course
False assumption: all health professionals
are able to recognise child abuse
An obsolete term?
• Physical assault
• Aka “physical abuse”
• Inflicted injury
• Intentional injury
• Often co-exists with other
forms of child abuse and
neglect (a continuum of
severity)
What babies are most at risk?
Ecological model for considering
the phenomenon Society
https://www.youtube.com/watch?v=l_toKPs9Jj4
Early identification of AHT can save lives
CONCLUSIONS: convergent
indirect evidence that crying,
especially in the first 4
months of age, is an
important stimulus for SBS.
seizures/convulsions
OUTLOOK
Outcomes are poor
As a direct result of shaking: Only 65 (22%) of those who
survived were considered to
– 19% died show no signs of health or
– 55% had ongoing neurological developmental impairment at
the time of discharge.
deficit (seizure disorders,
paralysis)
Interpretation: Shaken baby
– 65% had visual impairment, syndrome results in an
including blindness extremely high degree of
mortality and morbidity.
Ongoing care of these
The increased prevalence of children places a substantial
learning and behavioural burden on the medical
disorders may not be system, caregivers and
apparent for many years. society.
• Learning disabilities
• Physical disabilities
• Visual disabilities or blindness
• Hearing impairment
• Speech disabilities
• Cerebral Palsy
• Seizures
• Behaviour disorders
• Cognitive impairment
• Death
PREVENTION
New York
Postnatal information regarding the dangers of shaking
Asking parents to sign “commitment to not shake”
Dias et al. Preventing Abusive Head Trauma Among Infants and Young Children: A Hospital-Based, Parent
Education Program, Pediatrics 2005
http://www.purplecrying.info/
What do I do when I see an injury?
My Advice
• Be cautious
• Seek advice EARLY
• Be curious and courteous
• Be impartial and objective
• Be honest
• Be thorough
• Avoid bias (especially confirmatory bias)
• Never, ever guess!!!!
• Keep an open mind / consider LOTS of possibilities
Injury Documentation
Site
Size
Shape
Swelling
Colour
Contour
Contents
Edge
Base
Healing
Complications /
sequelae
Treatment
Bruises
The head is by far the commonest site of bruising caused
by assault
TEN 4 = ? NAI
Any bruises in child < 4 months
In child < 4 years – bruising on Torso,
Ears, Neck
Bruises
Non-abused children – bony prominences
• Bruising in babies
http://www.core-info.cf.ac.uk/bruising/index.html
Self-inflicted bruises & abrasions
• Older children
• Can co-exist with inflicted injury (eg
sexual assault)
• Tantrums = VERY COMMON
• Head banging
• Episodes of rage
Bone injuries ? NAI
BEWARE BE ALERT
Shaft > metaphysis Multiple fractures (esp
Classic Metaphyseal bilateral)
lesions Fractures of different
Rib fractures, esp ages
posterior
Uncommon
Rare Epiphyseal separations
Scapular Vertebral body
Spinous processes #/subluxations
Sternal Digital #
Complex skull #
Rib fractures