ARC ped - blessures inexpliquées

Question 1

FDR abus enfant

Answer 1

Child characteristics:

*Speech and language disorders, learning disabilities, conduct disorders, and non-conduct psychiatric disease [18,19] (see “Promoting safety in children with disabilities”, section on ‘Maltreatment or neglect’)

*Failure to thrive

*Congenital anomalies, intellectual disability or other disabilities, or chronic or recurrent illnesses [20]

*Attention deficit disorder with hyperactivity children [21,22]

*Prematurity and low-birth weight, although the data are conflicting [23-27]

*Unplanned pregnancy

*Unwanted child

●Environment:

*Unrelated adolescent or adult male caregiver in the household [28]

*Domestic or intimate partner violence [29]

*Animal cruelty [30]

*Acute or chronic family stressors (eg, divorce or interpersonal conflict, illness, or job loss)

*Living in poverty

*Social isolation (distant or absent extended family)

●Caregiver features:

*Young or single parents

*Parents with lower levels of education

*Unrealistic expectations for child; poor knowledge of child development

*Negative perception of normal child behaviors [31]

*Caregiver was abused or neglected as a child, leading to abuse or neglect of their own children as a learned behavior

*Substance or alcohol use disorder

*Poorly controlled psychiatric illness (eg, psychosis, depression, impulse disorder) [32]

Question 2

Red flags

Answer 2

●No history or denial of trauma despite severe injury

●Implausible history for degree or type of injury

●Unexplained or excessive delay in seeking care

●Severe injury explained as self-inflicted or blamed on other young children or pets

●Caregiver histories that change with retelling or conflict with versions from other observers

Question 3

Bruises (injury) highly associated with physical child abuse in children <4 years old (TEN-4-FACES-p)

Answer 3

T – Torso
E – Ear
N – Neck
F – Frenulum (including laceration or tear)
A – Angle of the jaw and any bruise in an infant <6 months old
C – Cheek (fleshy portion)
E – Eyelid
S – Subconjunctival hemorrhage
P – Patterned bruises (eg, loop, belt, handprint, or recognizable striking object)

Question 4

Fractures : Red flags

Answer 4

●Metaphyseal corner (or bucket handle) fractures (image 1 and image 2 and image 3 and figure 4)

●Rib fractures (image 4)

●Fractures of the sternum, scapula, or spinous processes

●Long bone fracture in a nonambulatory infant

●Multiple fractures in various stages of healing

●Bilateral acute long bone fractures

●Vertebral body fractures and subluxations and no history of high-force trauma

●Digital fractures in children younger than 36 months of age or without a corresponding history

●Epiphyseal separations especially eg, transphyseal distal humeral fractures

●Skull fractures in children younger than 18 months of age with a concerning history (table 3) and associated intracranial hemorrhage, especially subdural hematom

●Isolated long bone fractures in ambulatory children

●Linear skull fractures

●Clavicle fractures

●Subperiosteal new bone formation