Facial injuries. There may be trauma to the eyes, ears, nose, or
(f) Bald patches. Bald patches on the child's scalp interspersed with
normal hair growth often indicate physical abuse.
(g) Chest injuries. A radiological bone survey can reveal unusual
fractures of the ribs, lateral clavicle, scapula, and sternum. Such fractures should
arouse suspicion of child abuse.
(h) Abdominal injuries. Physical findings of abdominal injuries include
ruptured liver, spleen, or pancreas as well as intramural hematoma of the bowel.
Children with these injuries may have recurrent vomiting, abdominal distention, absent
bowel sounds, local tenderness, or shock. A ruptured liver or spleen is the most
common finding. Intramural hematomas can occur at the sites of ligmental support
such as the duodenum and the proximal jejunum. Intramural hematomas are caused by
the whipping force of a punch or blow. This injury is different from a ruptured spleen or
ruptured kidney injury, both of which can be caused by the crushing or compressing
forces of a traffic accident or a fall. Adults with a child who has an intramural hematoma
routinely deny that the child has had a blow to the abdomen. Therefore, in any case in
which a child has sustained an abdominal injury without a reasonable explanation, the
medical examiner should suspect child abuse.
b. Neglect and Emotional Abuse.
(1) Definition. Neglect involves failure to provide the necessities of life for a
child. There are many types of neglect: medical, educational, nutritional, psychosocial,
physical, and emotional neglect. Abandonment is also classified as a form of neglect.
The child who is under weight and malnourished may be a victim of nutritional neglect.
Children under two years old are most frequent sufferers from this type of neglect
because they are still dependent on adults for food and because the first two years are
the years of most rapid growth. Medical neglect (health care neglect) exists when a
child with a treatable chronic disease does not receive medical treatment despite
recommendations to the parents or caretakers. Physical neglect occurs when those
responsible for caring for the child do not take proper care of him. Included in physical
neglect are dirty hair, dirty or inadequate clothing, incomplete immunizations, unsanitary
home environments, unstimulating environments, inadequate after school supervision,
and excessive work. Such children should also be evaluated for the presence or
absence of severe emotional disturbances. Often, their parents are very depressed and
withdrawn. The failure to thrive syndrome (FTT) is part of this type of child abuse. All of
these forms of neglect have an emotionally damaging impact on the child.