2025 – PAGE 441 – PSYCHIATRY AND SOME SOCIAL ISSUES
CHILD ABUSE
Risk factors that increase the likelihood of child abuse include unwanted/unexpected pregnancies, prematurity, a greater number of young children in the home, and having children born with malformations/anomalies. Factors that do not increase the risk of abuse include gender of the child, overall size of the family, and parents’ education level.
PHYSICAL ABUSE
An act by a caregiver that results in significant injury or risk of injury. Obtain a skeletal survey and full physical exam. Report suspicions to the appropriate authorities, which can vary by state. The child victim may need foster home placement to assure safety.
COMMON ABUSE-RELATED FRACTURES
Fractures of the scapula, sternum, spinal processes, multiple ribs, skull, and any spiral fracture should raise suspicion for abuse-related fractures.
IMAGE: www.pbrlinks.com/CHILDABUSE1 – Healing rib fractures
BUCKET HANDLE FRACTURES AND CORNER FRACTURES
Bucket handle fractures and corner fractures are highly specific for abuse. They are fractures of the metaphysis caused by sudden pulling, which causes avulsions.
IMAGE: www.pbrlinks.com/CHILDABUSE2 – Bucket handle fracture
IMAGE: www.pbrlinks.com/CHILDABUSE3 – Corner fracture
NAME ALERT/PEARL: Buckle fractures are NOT associated with child abuse. Other fractures/conditions that are more likely due to an accident include linear skull fractures, supracondylar fractures of the elbow, and clavicle fractures.
RETINAL HEMORRHAGE (AKA SHAKEN BABY SYNDROME)
Caused by shaking a baby with force resulting in abusive head trauma from repetitive acceleration-deceleration injury. Injury can cause a subdural hematomas (SDH) and vision loss. Close follow-up with an ophthalmologist is recommended.
SEXUAL ABUSE AND ASSAULT
Can present with nonspecific symptoms such as enuresis and encopresis. Often presents with fears, phobias, and sleep disorders. Also, with hyperactivity, learning problems, sexualized play, and a distorted mature personality development. Interview and examine the child in a specialized setting with a multidisciplinary staff, which may include a Sexual Assault Nurse Examiner (SANE) or a Sexual Assault Response Team (SART), to provide comfort to the child and the ability to photograph and videotape the relevant parts of the exam. Laboratory evaluation includes a pregnancy test if the victim is an adolescent female, and work-up for sexually transmitted infections (STIs) and trauma. Report all suspicions to the authorities.
PSYCHOLOGICAL ABUSE
Psychological abuse is common but underreported because most victims do not seek help and because there are no physical signs of abuse. Social media is frequently a means of psychological abuse. Abuse may start with name-calling but can build into more threatening language and actions (such as yelling, swearing, or isolating a child from meaningful activities). The abuse can lead to self-injurious behavior or even suicide. The goal should be to remove the child from the abuser and file a report with the authorities.