HD 300 Child Abuse & NeglectBackground InformationRole of the PhysicianER Protocols“Red Flags” on Patient History“Red Flags” on ExamRed Flags on ExamTypical Sites for Abusive InjuriesSlide Number 9Types of Abusive MarkingsTypes of Abusive MarkingsBurn InjuriesRecognizing Abusive InjuriesSlide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Number 21Slide Number 22Slide Number 23Slide Number 24Slide Number 25Slide Number 26Slide Number 27Slide Number 28Slide Number 29Slide Number 30Slide Number 31Slide Number 32Slide Number 33Slide Number 34Slide Number 35Slide Number 36Slide Number 37Slide Number 38Slide Number 39Slide Number 40Injuries Commonly Seen in ERInjuries Commonly Seen in ERInjuries Commonly Seen in ERHD 300Child Abuse & NeglectUnit 7Response of Medical CommunityBackground Information15% of children brought in for treatment have been treated previously for similar injuries77% of those receiving treatment are under the age of 15 monthsRole of the PhysicianOnly needs to have “reason to suspect” that abuse has taken place in order to reportIf abuse is suspected or confirmed, the physician can order “protective custody” for 72 hoursER ProtocolsIdentify presenting signs and symptomsObtain a medical historyDo preliminary examPreserve forensic specimens and maintain chain of custodyProvide written record of exam & treatmentPromptly reportProvide follow-up counseling & services“Red Flags” on Patient History“Magical” injuryAvoidable injuryRepeated injury (several injuries to same area)Delay in medical careParents under or overestimate injuryChild fits a profile for risk“Red Flags” on ExamInjury/history mismatchSuspicious injuryMultiple injuriesInjuries in various stages of healingDifferent injury formsRed Flags on ExamOverall poor carePoisoningFailure to thriveUnexplained physical findingsTypical Sites for Abusive InjuriesButtocks, lower backBack of legsGenitals, inner thighsCheeksEar lobesUpper lipNeck (show spinning graphic)Types of Abusive MarkingsBelt Buckle Belt Strap Looped Cord Stick/WhipFly Swatter Coat HangerBoard SpatulaTypes of Abusive MarkingsHand Knuckles Bite MarksSauce PanPaddlesSpoonFork TinesBurn InjuriesLight Bulb Hot Plate Curling Iron Car Cigarette LighterIron Knives Grid Cigarette ImmersionRecognizing Abusive InjuriesThe 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 buttocksBruises of different ages. The site is also unusual for accidental injury.Bilateral bruising under eyes. “Racoon Eyes”Slap mark on an infantGrab 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 childSkin lesions caused by a wire brushBelt marks located on the back of the thighs and lower legsCord marksMarks with a linear patternon back of young childLigature marksBruising behind earLip injuryAttempted strangulationTraumatic alopecia (hair loss from pulling)Subconjunctival hemorrhageBlowout fracture of the orbit of the eyeImmersion burns (mitten burns)Immersion burnsRunning water burnBurn from open flameGrid burnGrid burnsBurn from cigarette lighterLighter burnInjuries Commonly Seen in ERScalp swelling and/or bruisingRetinal hemorrhage (inside eye)Skull fractureBlack eyesInjuries Commonly Seen in ERAbdominal injuries (external & internal)FracturesSIDS (reported by parents)Failure to thriveSexual injuriesInjuries Commonly Seen in ERTraumatic alopecia (hair loss/bald patches)Subdural and epidural hematomas (MRI)Scraping and/or scratchingBurnsBruises – varying