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Findings in Child Abuse. Reena Desai, MIV. Child Abuse. Includes physical, sexual, emotional abuse, and neglect Nearly 1.4 million children are victimized each yr. 160,000 suffer from serious injuries and 1200 children die each yr.

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Findings in child abuse

Findings in Child Abuse

Reena Desai, MIV


Child abuse
Child Abuse

  • Includes physical, sexual, emotional abuse, and neglect

  • Nearly 1.4 million children are victimized each yr. 160,000 suffer from serious injuries and 1200 children die each yr.

  • Risk factors include the following: low income households, mutiple children, single mother, etc…


H p red flags
H&P red flags

  • Most common injuries include bruises, bites, burns, fractures, head trauma, and abdominal trauma

  • Story of injury inconsistent with physical findings

  • Unexplained injuries to buttocks, thighs, torso, ears, and neck

  • Lesions in various stages of healing


Diagnostic imaging
Diagnostic imaging

  • Skeletal survey

  • CT

  • MRI

  • Bone Scan


Bone injuries
Bone Injuries

  • High specificity : Fractures to metaphysis, posterior ribs, scapula, spinous process, and sternum

  • Moderate specificity: Mult. Fractures, fractures of different ages, epiphyseal separations, vertebral body fractures and subluxations, digital fractures, complex skull fractures


Bone injuries1
Bone Injuries

  • Low specificity: Subperiosteal new bone formation, clavicular fractures, long bone shaft fractures, and linear skull fractures


Tools to evaluate bone injuries
Tools to evaluate Bone injuries

Up to 2 yrs of age- skeletal survey w/ follow up survey in two weeks w/ possible bone scan.

5+ yrs.- Radiographs based on clinical findings


Skeletal survey
Skeletal Survey

  • Appendicular Skeleton

  • Humeri (AP)

  • Forearms (AP)

  • Hands (Oblique and PA)

  • Femurs (AP)

  • Lower Legs (AP)

  • Feet (AP)


Skeletal survey1
Skeletal Survey

  • Axial Skeleton

  • Thorax (AP and lateral), to include thoracic spine and ribs

  • Abdomen, lumbosacral spine, and bony pelvis (AP)

  • Lumbar spine (lateral)

  • Cervical Spine (lateral)

  • Skull (frontal and lateral)

  • AP = anteroposterior;  PA = posteroanterior







Humeral shaft fracture
Humeral Shaft Fracture fallen from changing table



Skull brain injuries
Skull/ Brain injuries move arm

  • Skeletal survey to show skull fractures

  • CT w/o contrast for acute injuries

  • MRI is more sensitive than CT for detecting contusions, traumatic venous thrombosis, and older injuries

  • Common injuries include cerebral contusions and subdural hematomas


Cerebral edema
Cerebral Edema move arm



Abdominal injuries
Abdominal Injuries consciousness

  • Commonly caused by blunt trauma

  • Use CT first

  • Other follow up studies may be necessary

  • Common injuries include hematomas of the duodenum and jejunum

  • Other injuries include liver lacerations and pancreatitis.


Liver injury
Liver injury consciousness


Duodenal hematoma
Duodenal Hematoma consciousness


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