HD 300 Child Abuse Neglect Unit 7 Response of Medical Community Background Information 15 of children brought in for treatment have been treated previously for similar injuries 77 of those receiving treatment are under the age of 15 months Role of the Physician Only needs to have reason to suspect that abuse has taken place in order to report If abuse is suspected or confirmed the physician can order protective custody for 72 hours ER Protocols Identify presenting signs and symptoms Obtain a medical history Do preliminary exam Preserve forensic specimens and maintain chain of custody Provide written record of exam treatment Promptly report Provide follow up counseling services Red Flags on Patient History Magical injury Avoidable injury Repeated injury several injuries to same area Delay in medical care Parents under or overestimate injury Child fits a profile for risk Red Flags on Exam Injury history mismatch Suspicious injury Multiple injuries Injuries in various stages of healing Different injury forms Red Flags on Exam Overall poor care Poisoning Failure to thrive Unexplained physical findings Typical Sites for Abusive Injuries Buttocks lower back Back of legs Genitals inner thighs Cheeks Ear lobes Upper lip Neck show spinning graphic Types of Abusive Markings Belt Buckle Belt Strap Fly Swatter Coat Hanger Looped Cord Board Stick Whip Spatula Types of Abusive Markings Hand Paddles Knuckles Bite Marks Fork Tines Sauce Pan Spoon Burn Injuries Light Bulb Iron Hot Plate Knives Curling Iron Grid Car Cigarette Lighter Cigarette Immersion Recognizing Abusive Injuries The following slides showing injuries on abused children were prepared by the C Henry Kempe National Center for the Prevention and Treatment of Child Abuse and Neglect Denver CO Caution Some of these slides are graphic and may be disturbing Normal bruising on an active child Acute facial bruising in a child who is not yet crawling Bruised buttocks Bruises of different ages The site is also unusual for accidental injury Bilateral bruising under eyes Racoon Eyes Slap mark on an infant Grab marks In cases of Shaken Baby Syndrome these marks would appear on the upper arms or torso Human bite mark on the skin of an abused child Skin lesions caused by a wire brush Belt marks located on the back of the thighs and lower legs Cord marks Marks with a linear pattern on back of young child Ligature marks Bruising behind ear Lip injury Attempted strangulation Traumatic alopecia hair loss from pulling Subconjunctival hemorrhage Blowout fracture of the orbit of the eye Immersion burns mitten burns Immersion burns Running water burn Burn from open flame Grid burn Grid burns Burn from cigarette lighter Lighter burn Injuries Commonly Seen in ER Scalp swelling and or bruising Retinal hemorrhage inside eye Skull fracture Black eyes Injuries Commonly Seen in ER Abdominal injuries external internal Fractures SIDS reported by parents Failure to thrive Sexual injuries Injuries Commonly Seen in ER Traumatic alopecia hair loss bald patches Subdural and epidural hematomas MRI Scraping and or scratching Burns Bruises varying ages