[Diagnosis] : Physical Abuse
Like other forms of abuse, physical findings alone are not usually diagnostic of physical abuse. Any time there is a lack of history, a history that changes over time, or a history that does not make sense when compared to the injury, the diagnosis of physical abuse is indicated. In addition, there are some constellations of injury that are often associated with intentional injury, including:
- Infants may present as "shaken" infants. The finding may include retinal hemorrhages, subdural hemorrhages, rib fractures and/or metaphyseal fractures. Infants who have been shaken may or may not have associated other injuries.
- Toddlers may present with scald burns, such as a scald pattern on the buttocks and/or feet with a "doughnut hole" spared area on the buttocks. These injuries may have "tide" marks where the burned skin begins and normal skin ends. Inflicted burns generally do not have splash marks because the child is held in position. Scald burns may or may not be associated with other injuries.
- Older children may present with bruises or fractures resulting from excessive corporal punishment. These may be pattern injuries and resemble the outline of the striking object. Bruises commonly occur on the buttocks and extremities.
General Principles of Injury Evaluation
- Is the history consistent with the mechanism of trauma?
- Is the child developmentally able to self-inflict this injury?
- Is there any other medical explanation for the injury or finding, such as illness or genetic condition?
- Is there corroborative information?
