Fractures in various possible areas are the second most common sign of abuse, including depressed or common fractures to both sides of the skull. The nature of the fracture gives strong clues, for example the so called bucket handle fracture is usually a sign of abuse. Burns are also frequently due to abuse, whether from deliberate intent from the parent or neglect which has allowed the child to burn itself.
When severe head trauma is suspected, an examination of the eye can reveal probable abuse since the pattern of haemorrhaging may be characteristic in an infant who has been violently shaken. Multiple haemorrhages which extend through multiple layers in the retina usually indicate abuse.
Child abuse has many medical consequences. Children in hospital who have been abused or neglected have more severe injuries, longer hospital stays, worse medical outcomes, and are more likely to die in hospital than children admitted for reasons not connected to abuse.
Many countries have laws which force doctors to report suspected abuse. The Seminar acknowledges the difficulties reporting abuse can involve, such as anger from the parents. The authors say: "Reporting of child maltreatment is not easy. But ensuring the child's safety is the priority, and reporting could be life saving."
The interventions needed to protect a child suffering abuse depend on the individual circumstances, but doctors should know the law, regulations and programmes in place for maltreatment in their area. Working with colleagues in other areas such as mental health and government departments can also help address all forms of child malt
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Contact: Professor Howard Dubowitz
hdubowitz@peds.umaryland.edu
410-706-6144
Lancet
31-May-2007