i. The child was injured several days earlier. Parents who do not abuse their
children seek medical care immediately when a child is injured. Abusive parents, on the
other hand, often delay treatment, pretending the event did not happen or that the injury
is not serious and will take care of itself.
j. The injured child has been seen at several different medical treatment
facilities recently for injuries. Abusive parents take an often injured child to different
doctors or hospital emergency rooms, hoping to avoid detection of child abuse.
CIRCUMSTANCES THAT AROUSE SUSPICION OF CHILD ABUSE
Physical findings, patient history, laboratory data, and your observations of the
child may indicate that the child has been abused.
a. Physical Findings. Look for the following.
(1) Multiple fractures of the extremities. Fractures of the arms and/or legs in
different stages of healing usually indicate that the child has been abused. A
radionuclide bone scan should be done to detect recent fractures.
(2) Multiple bruises and abrasions. Look especially around the child's trunk
and buttocks. Be particularly suspicious if there are old bruises in addition to fresh
ones. Also, check the child's head and face. Fifty percent of physical child abuse
injuries are to the head and face.
(3) Multiple soft tissue injuries. A child who has had a bottle forced into its
mouth will have multiple soft tissue injuries around the mouth. There will be bruises
around the child's mouth.
(4) Burns. Look for the round circles made by cigarette burns. Hot water
poured on infants will cause scald burns.
b. Child's Medical History. A child who has been in several emergency rooms
recently for related complaints may be a victim of abuse. In a military hospital, check
the child's medical records. Additionally, a child brought in for treatment of an injury
which occurred several days ago may have been abused.
c. Laboratory Reports for the Child. A complete physical examination
containing laboratory tests and reports will sometimes provide the first medical evidence
that an unreported injury has occurred to the child in the past. For instance, if you
suspect that a child under 3 years of age has been abused, a nuclear scan of the child's
bones may be revealing. X-ray films may not reveal recent injuries that have begun to
heal. A nuclear scan of the child's bone structure will show such injuries. CT scans are
usually taken for children with head injuries. Conventional X-ray films should also be
taken of the head because CT scans may miss skull fractures.