Young infants, less than six months old are subject to child maltreatment and have rates of physical and abusive trauma twice the rate of children one to three years in age (Harper, et.al., 2014). Abuse symptoms most often seen in non-mobile infants are bruising, burns, fractures and traumatic brain injuries. Infants have a wide variety of developmental ability and mobility, but in general they are not mobile enough to sustain fractures, or get into things in their environment that would cause the injuries that they may present with. Often with infant abuse, mother’s or parents bring their infants to be evaluated for difficult temperaments or excessive crying. The provider may notice bruising, and when assessing and questioning the parent may give inconsistent stories on how or when the bruising appeared. Bruising in any pre-mobile infant is a red flag for abuse with high suspicion for more serious internal injuries (Harper, et.al., 2014). Injuries of this nature should always lead to further investigation. On imaging studies, fractures may be seen on the skull, in long bones of legs and arms as well as hands and feet. Multiple fractures of varying stages of healing almost always are attributed to infant abuse. Fractures in the absence of trauma confirms the likelihood of physical abuse and the incidence is higher the younger the child (Paddock, Sprigg, &Offiah, 2017). Failure to thrive, threatening weight loss, uncleanliness and diapering may also lead the provider to further investigations of suspected abuse. The most serious of abuse and injuries is that of shaken baby syndrome, resulting in traumatic brain injury, retinal hemorrhages, and intracranial bleeds. An emotional assessment can be difficult in infancy in revealing abuse. Although, infants can be withdrawn or cry excessively from the pain of physical injuries. Traditional cultural healing can also be misidentified as abuse, when the provider visualizes burns, abrasions, or petechial marks on the chest or back of infants. For example, in the Asian community treatment of cough and fever may be alleviated by heated ointments applied by metal coins or spoons. Minor burns may result from the vigorous rubbing of heated herbs and appear as linear abrasions or bruising (Stanford Medicine, 2017).
As a medical professional and nurse, I am a mandated reporter of suspected abuse. There are often medical diagnosis that can lead to injuries that mimic abuse, although in California they do not need to be ruled out prior to reporting. The standard for which a report should be made is “reasonable suspicion” (Rady’s Children’s Hospital San Diego, 2012). Failure to report can result in a misdemeanor, imprisonment, and fines. Reports should be made immediately or as soon as possible to the county child welfare services or police/sheriff’s department. The report can be made by phone or written report transmitted by fax, mail or electronically.
Harper, N. S., Feldman, K. W., Sugar, N. F., Anderst, J. D., & Lindberg, D. M. (2014). Additional Injuries in Young Infants with Concern for Abuse and Apparently Isolated Bruises. The Journal Of Pediatrics, 165383-388.e1. doi:10.1016/j.jpeds.2014.04.004
National Center on Shaken Baby Syndrome (2016). Retrieved from https://dontshake.org/learn-more
Paddock, M., Sprigg, A., & Offiah, A. (2017). Imaging and reporting considerations for suspected physical abuse (non-accidental injury) in infants and young children. Part 1: initial considerations and appendicular skeleton. Clinical Radiology, (3), 179. doi:10.1016/j.crad.2016.11.016
Rady Children’s Hospital San Diego (2012). The California Child Abuse and Neglect Report Law. Retrieved from http://mandatedreporterca.com/images/pub132.pdf
Standford Medicine (2017). Retrieved from http://childabuse.stanford.edu/faq.html
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