Child Abuse Injuries: Part 2/2

May 2, 2019April 27, 2019 / Jordyn Redwood / 4 Comments

April is Child Abuse Awareness Month. Last post, I covered how a given history for an injury may be a signal that an injury was intentionally inflicted. Today, I’m going to cover how the injury itself may give off clues for an abusive injury.

1. The injury is beyond the child’s developmental level. You’ll notice this is the first clue I gave concerning the history, but it also plays into the injury itself and I’m going to talk specifically about infants. Any bruising in an infant to the face, head and neck when they are not yet pulling themselves up to a standing position is concerning for abuse. To create an injury, you have to fall off of or run into something and you need to have some velocity behind it. Now, of course, injuries in this age group can have lots of accidental causes, but the story needs to match the injury.

2. The injury has a pattern. Consider typical childhood bruises. They are roundish in shape, of varying circumferences, and received from a low-velocity type injury . . . say the child running into a counter with their forehead. Anything that makes a visible pattern generally requires high-velocity force to imprint the pattern onto the skin. If I loop a belt and tap you with it, there likely won’t be any injury at all. However, if I take it and swing it at you like a pitcher throwing a baseball, it has the potential to create a loop like bruise.

3. The injury is not over a bony prominence. Again, if you have children, think back to their younger days when injuries were common. When they fell, where did they bruise? Head (scalp, forehead, nose, chin), elbows, shins, and knees. Most often, kids fall or run into something in a forward motion. Bruising to the buttocks in a diapered child is particularly concerning. Often, they will fall onto their bottoms, but they also have extra padding.

4. There are a lot of bruises. This is not definitive but can be a signal for abusive injury, particularly if the pattern is not a normal bruising pattern as in #3.

None of these items is taken in isolation as a single indictment against the caregiver. Let’s say you accidentally drop a toy onto your two-month-old’s face while cleaning up. It causes a bruise and you want it checked by the pediatrician. The pediatrician is not going to report you. Why? You have a plausible story (dropping something onto the baby’s face), it is a low velocity injury (the bruise is probably small and round) and there is only one.

Medical professionals look at the totality of the child’s case: the history, the social environment, and the injury is considered before a report to child services is made. Reports are not made lightly.

The above offers some beginning guidelines. In the comments section, give a specific injury that might be concerning for abuse.

Child Abuse Injuries: Part 1/2

April 29, 2019April 27, 2019 / Jordyn Redwood / 1 Comment

Nothing is more heartbreaking than to take care of a child that has been abused. April is Child Abuse Awareness Month so I thought I’d do a few posts about child abuse injuries and how medical providers pick up on the fact an injury may be intentional or inflicted.

As a pediatric nurse, I’ve been witness to child homicide at the hands of abuse. Yes, it is murder. It’s a necessary part of my job in dealing with these families, perhaps even the confessed abuser, as I care for the child abuse victim. And yes, there is a lot of conflict in these situations.

How do we as pediatric medical providers begin to suspect that an injury is abusive? During the initial evaluation of an injury, confession among abusers is rare (perhaps, they will confess later.) Often, there is a history given to account for the injury. Both parts: the history of the injury and the injury itself can give red flags for abuse. Today, let’s examine the story and how it may signal an abusive injury.

1. The story not realistic considering the child’s developmental level. This is more common than you might think. Most people cannot rattle off when a child should meet certain developmental milestones so they’ll say the child injured themselves in a manner that is beyond their developmental age. For instance, “my daughter broke her arm by rolling off the couch”. The baby is two-weeks old. Infants typically roll over starting at 3 months. Here’s a great resource for any writer/parent for developmental milestones.

2. The story changes. Just like other criminals, abusers can have a hard time keeping their story straight. Often times, the more abusers are questioned about the plausibility of the story, it will begin to change. Medical staff interviewing a potential abuser can be like a detective getting a criminal to confess. The doctor will often approach the caregiver several times to ask questions about the injury to see if the story changes. In later interviews, the doctor may say, “This injury is suggestive of abuse.”

3. The story has too much detail. This one may seem odd, but it can be a red flag for abusive injuries. If you have children, think back to their toddler/elementary school years when they seem to come home with lots of bumps, bruises, cuts and scrapes. If asked, could you come up with an explanation for each and every injury? Likely, no. Abusers will try and explain away every injury. A non-abusive parent will be truthful and likely say, “I have no idea how that happened.” and then probably feel guilty about not knowing.

What other parts of a medical history/story might give a signal for abusive injury?

Forensic Medical Question: Forensic MRI for Child Abuse

November 18, 2016November 17, 2016 / Jordyn Redwood / 1 Comment

Susan Asks:

mri-782459_1920 Is there such a thing as a forensic MRI? Not to be done on a dead person, but in a child abuse case? Can one tell if a child has been beaten and see healed bruises, etc?

Jordyn Says:

Thanks for your questions.

The only indication I can think of using MRI to discern abuse would be for head trauma. MRI is the most sensitive study when it comes to differentiating old and new bleeds (as in possibly discerning two episodes of shaking), but still an exact time of the bleed could probably not be given. We just would know there were two separate instances of injury that caused bleeding.

Also, it wouldn’t be called a forensic MRI on a live child. We would just call it by the study we’re doing. In this case, a brain MRI, but the reason for doing the study would be concern for child abuse and/or intracranial (inside the brain) bleeding.

You can’t really tell healed bruises because they’re healed after all. The skin would have normal appearance. We could at least take a history of where the bruises were because we know normal versus abnormal bruising patterns in children, but pictures are always more impressive so seeing current injuries will always be better if trying to build a child abuse case.

Perhaps you’re thinking about healed fractures which you could possibly see some evidence of healed fractured on x-rays depending on how significant the fracture was. However, not all healed fractures are visible on x-ray. Healing fractures can be seen on x-ray.