CHILD ABUSE

"High-risk parent-child interaction"

• Unrealistic expectations
• Isolated parent; esp. teenage parents living alone

Physical signs

Shaking--rarely causes injury in >1yo; causes long-bone metaphyseal fx, esp. bilat horiz. metaphyseal fx; subdural/subarachnoid hemorr.

• Rib Fx, from grabbing & squeezing; almost never result from falling or other accidents
• Battle's sign; racoon eyes
• Multiple spiral fx.
• Wounds in various stages of healing.
• Accidental discovery of injury during complete exam
• Cognitive development should be assessed if neglect suspected

Diff dx:

• Dermatomyositis--looks like burns
• Osteogenesis imperfecta
• Leukemia--easy bruising due to thrombocytopenia
• Congen. syphilis
• Birth injury

Serum transaminase levels may be elevated in children with abdominal trauma from abuse