Non-accidental trauma (NAT); Child abuse
Battered child syndrome refers to children who have undergone physical abuse that has left them with both physical and psychological trauma.
Causes, incidence, and risk factors
Physical abuse of children occurs in every socioeconomic class, though it is most common amongst the poor due to increased stress and greater lack of control over stressful circumstances.
Abuse tends to occur at moments of greatest stress, when the perpetrator strikes out in anger at the child. Many perpetrators were themselves abused as children and they often don’t realize that abuse is not appropriate discipline. Abusers also frequently have poor impulse control, which prevents them from thinking through the consequences of their actions.
Because of the relative size and strength difference between adults and children, the abused child can be severely injured or killed unintentionally. Shaking an infant, for example, can cause bleeding over the brain (subdural hematoma) which can cause permanent brain damage or death (shaken baby syndrome).
The incidence of child abuse is remarkably high. The total abuse rate is 25.2 per 1,000 children with physical abuse counting for 5.7 per 1000, sexual abuse 2.5 per 1,000, emotional abuse 3.4 per 1000 and neglect accounting for the vast majority, 15.9 per 1,000 children. Of course, these categories often overlap, with sexual and physical abuse often occurring together and with sexual abuse, physical abuse or neglect seldom occurring without emotional abuse.
These numbers may also be underestimates due to failure to diagnose or report this problem. Risk factors include poverty, lack of education, single parenthood, alcoholism or other drug addictions and a host of other factors.
- Appearance at an emergency room with an injured child and one or both of the following: o An improbable explanation of the cause of the injury o An injury that is not recent
- Bruise marks shaped like hands, fingers, or objects (such as a belt)
- Specific patterns of scalding (seen when a conscious child is immersed in hot water)
- Burns from an electric stove, radiator, heater or other hot objects on the child’s hands or buttocks
- Cigarette burns on exposed areas or the genitals
- Black eyes in an infant
- Human bite marks
- Lash marks
- Choke marks around neck
- Circular marks around wrists or ankles (twisting)
- Separated sutures
- Bulging fontanelle
- Unexplained unconsciousness in infant
Signs and tests
Physical examination may show other injuries, such as:
- Multiple retinal hemorrhages (bleeding in the back of the eye)
- Internal damage such as bleeding or rupture of an organ from blunt trauma
- Any fracture in an infant that is too young to walk or crawl
- Evidence of epiphyseal fractures (often multiple) of long bones or spiral type fractures that result from twisting
- Fractured ribs
- Evidence of skull fracture (multiple fractures of different ages may be present)
- Subdural hematoma (collection of blood in the brain) without plausible explanation
Tests that reveal physical injuries include:
- Bone X-ray
- Skull X-ray and/or MRI or CT scan
Physical injuries are treated as appropriate for the specific injury. Counseling or intervention of some type for the parent(s) is mandatory. Life-threatening abuse or abuse resulting in permanent damage to the infant or child may result in incarceration for the perpetrator. In some cases, the child may be temporarily or permanently removed from further danger.
Many states require that known or suspected child abuse be reported to the police, and reporting is automatic. Child protection services are also notified. The disposition of the child will be determined by the severity of the abuse, the likelihood of recurrence, and other factors. Decisions regarding placing the child with an outside caregiver or returning the child to the home usually are made by the appropriate government agency through the court system. The structure of these agencies varies from state to state.
Support groups are available for survivors of abuse and for abusive parents who want to get help. See the resource page for contact information.
The child’s recovery depends on the severity of the injuries, and the outcome of the family or abuser rests with the authorities. Child protection agencies generally make every effort to reunite families when possible.
Physical abuse of a child can lead to severe brain damage, disfigurement, blindness, crippling, and death. Abused individuals may carry emotional scars for a lifetime. Children can be removed permanently from the parents’ custody if the parents are the perpetrators and the cause is sufficient to warrant termination of parental rights.
Calling your health care provider
Call your health care provider or protective services if you suspect or know that someone is being abused.
Recognition of pending abuse can help prevent actual abuse. Warning signs include the following:
- Abuse history (such as previous abuse of the child or the child’s siblings)
- Lack of apparent parental love or concern
- Failure to maintain the child’s proper hygiene or care
- Parental alcohol or drug problems
- Parental emotional problems or mental illness
- History of abuse in the parent’s childhood
- High stress factors in the family life
Intervention with counseling may prevent abuse when any of these factors are present. Watchful guidance and support from the extended family, friends, clergy, or other supportive persons or groups may prevent abuse or may allow early intervention in cases of abuse.
by Brenda A. Kuper, M.D.
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.