pediatrics
Overview of Child Maltreatment
Symptoms and Signs of Child Maltreatment
Symptoms and signs depend on the nature and duration of the abuse or neglect. are the most common findings. Skin findings are usually subtle (eg, a small bruise, petechiae on the face and/or neck) ( Symptoms and signs reference ). More severe findings may include Handprints or oval fingertip marks caused by slapping or grabbing and shaking Long, bandlike ecchymoses caused by belt whipping Narrow arcuate bruises caused by extension cord whipping Multiple small, round burns caused by cigarettes Symmetric scald burns of upper or lower extremities or buttocks caused by intentional immersion Bite marks Thickened skin or scarring at the corners of the mouth caused by being gagged Patchy alopecia, with varying hair lengths, caused by hair pulling Fractureshighly indicative of physical abuse include classic metaphyseal lesions (usually caused by shaking an infant or toddler), rib fractures, and spinous processes fractures. Fractures most frequently associated with physical abuse include skull fractures, long bone fractures, and rib fractures. In children<1 year old, about 75% of fractures are inflicted by others. Confusion and localizing neurologic abnormalities can occur with central nervous system injuries. Lack of visible head lesions does not exclude traumatic brain injury, particularly in infants subjected to violent shaking. These infants may be comatose or stuporous from brain injury yet lack visible signs of injury (with the common exception of retinal hemorrhage) or they may present with nonspecific signs such as fussiness and vomiting. Traumatic injury to organs within the chest or abdominal/pelvic region may also occur without visible signs. Older children who are frequently abused are often fearful and irritable and sleep poorly. They may have symptoms of Depressive Disorders in Children and Adolescents , Lack of visible head lesions does not exclude traumatic brain injury in children who have been abused. In most cases, children do not spontaneously disclose sexual abuse and do not always exhibit behavioral or physical signs of sexual abuse. If a disclosure is made, it is generally delayed, sometimes days to years. In some cases, abrupt or extreme changes in behavior may occur. Aggressiveness or withdrawal may develop, as may phobias or sleep disturbances. Some sexually abused children act in ways that are sexually inappropriate for their age. Physical signs of sexual abuse that involves penetrationmay include Difficulty walking or sitting Bruises or tears around the genitals, anus, or mouth Vaginal discharge, bleeding, or pruritus Other manifestations include a sexually transmitted infection or pregnancy. Within a few days of the abuse, examination of the genitals, anus, and mouth will likely be normal, but the examiner may find healed lesions or subtle changes. In early infancy, emotional abuse may blunt emotional expressiveness and decrease interest in the environment. Emotional abuse commonly results in failure to thrive and is often misdiagnosed as intellectual disability or physical illness. Delayed development of social and language skills may be a sign of inadequate parental stimulation and interaction. Emotionally abused children may be insecure, anxious, distrustful, superficial in interpersonal relationships, passive, and overly concerned with pleasing adults. Children who are spurned may have very low self-esteem. Children who are terrorized or threatened may seem fearful and withdrawn. The emotional effect on children usually becomes apparent at school age, when difficulties develop in forming relationships with teachers and peers. Often, emotional effects are appreciated only after the child has been placed in another environment or after aberrant behaviors abate and are replaced by more acceptable behaviors. Children who are exploited may commit crimes or develop a substance use disorder. Undernutrition, fatigue, poor hygiene, lack of appropriate clothing, and Failure to Thrive (FTT) in Children are common signs of inadequate provision of food, clothing, or shelter. Stunted growth and death resulting from starvation or exposure to extremes in temperature or weather may occur. Neglect that involves inadequate supervision may result in preventable illness or injury. 