Can TEN4 distinguish bruises from abuse, inherited bleeding disorders or accidents?

Identifying inflicted injuries in infants and young children

Child physical abuse is a common cause of pediatric morbidity and mortality. Up to half of all children presenting with abusive injuries have a history of a prior suspicious injury, suggesting a pattern of repeated physical abuse. Medical providers are responsible for identifying children with suspicious injuries, completing mandated reporting to child protective services for investigation, and screening for occult injuries and underlying medical conditions that can predispose to injuries. Early identification of inflicted injuries appropriate evaluations may serve as an opportunity for life-saving intervention and prevent further escalation of abuse. However, identification of abuse can be challenging. This article will review both physical exam findings and injuries that suggest abuse as well as the evaluation and management of physical abuse.

Orofacial manifestations of child maltreatment: A review

The recognition and reporting of child abuse and neglect continues to be a challenge in the healthcare setting. All healthcare providers, including dentists, should be aware of the high prevalence of orofacial injuries and conditions that are concerning for abuse and neglect. Sentinel injuries may appear trivial and do not require medical attention, but are unlikely caused by accidental mechanisms and, if not properly identified, often precede more severe abusive injuries. Concerning orofacial findings can manifest as bruising, eye injuries, intraoral injuries, pharyngeal perforations, facial bone fractures, and sexually transmitted infections. Abusive caregivers are likely to give inadequate explanations or no history at all to explain concerning findings. Medical providers' failure to make mandated reports about their concerns to the appropriate agencies can have significant long-term impacts on the physical and psychological well-being of children.

Barriers to identification and reporting of child abuse and neglect experienced by medical officers and nursing staff in emergency departments of the Nepean Blue Mountains Local Health District

OBJECTIVE

This structured survey sought to identify barriers to recognising and reporting potential child abuse by medical officers and nursing staff in the EDs of three Western Sydney hospitals. These include a large metropolitan teaching hospital, a small metropolitan hospital and a rural hospital.

METHODS

A mixed approach of qualitative and quantitative study methodology was used to survey potential participants. The electronic survey was distributed to participants to assess knowledge and experiences with identifying child abuse presenting to the ED over a 6-month period. A descriptive analysis of the data was performed.

RESULTS

A total of 121 responses were received from 340 potential participants, giving a participation rate of 35%. The majority of the respondents were senior medical officers (38/110, 34%) or registered nurses (35/110, 32%). The study participants perceived the lack of time as the most significant barrier to reporting child abuse (85/101, 84%). This was followed by a lack of education (35/101, 34%), resources (33/101, 32%) and support (30/101, 29%).

CONCLUSION

The combination of hospital, departmental and individual staff issues such as time limitations, lack of resources, education and support are potential barriers to reporting suspected child abuse. We recommend tailored teaching sessions, improved reporting procedures and increased support from senior staff to overcome these barriers.

Fifteen-minute consultation: Bruising in the premobile child

A bruise in a premobile infant is an uncommon finding and often results in referral to the paediatric or emergency departments, acknowledging the potential for physical abuse in this vulnerable cohort. Our role as clinicians is to undertake a thorough assessment, consider potential differentials and organise appropriate investigations, with involvement of the wider multidisciplinary team. In this article, we use a case vignette to discuss how one would approach a bruise in the premobile infant including the evidence base.