Browse > Article

A Clinical Study of Child Abuse  

Choi, Yoon Jin (Department of Pediatrics, College of Medicine, Hallym University)
Kim, Shin Mi (Department of Pediatrics, College of Medicine, Hallym University)
Sim, Eun Jung (Department of Pediatrics, College of Medicine, Hallym University)
Cho, Do Jun (Department of Pediatrics, College of Medicine, Hallym University)
Kim, Dug Ha (Department of Pediatrics, College of Medicine, Hallym University)
Min, Ki Sik (Department of Pediatrics, College of Medicine, Hallym University)
Yoo, Ki Yang (Department of Pediatrics, College of Medicine, Hallym University)
Publication Information
Clinical and Experimental Pediatrics / v.50, no.5, 2007 , pp. 436-442 More about this Journal
Abstract
Purpose : To promote awareness and efforts by pediatricians to identity and prevent child abuse by investigation of characteristics of victim and types of injury caused by abuse. Methods : A retrospective study was performed with 20 patients who had been diagnosed or suspected as child abuse at Hallym University Hospital from January 1999 to December 2005. The medical records, radiologic documents, and social worker's notes were reviewed to investigate age, sex, visiting time, form of abuse, perpetrator, risk factor, and type of injury. Results : The mean age of the subjects was 2.8 years. Fourteen patients were between 0-1 years old, 2 patients between 1-6 years old, 3 patients between 7-12 years old, and 1 case over 13 years old. The ratio of male to female was 1:1. The majority of these patients (70%) visited via emergency department. Eight five percent of these patients reported with physical abuse, 5% psychological abuse, 5% sexual abuse, and 5% neglect respectively. The suspected perpetrator was the biological father in six cases, the biological mother in three cases, the stepmother in two cases, caregiver in one case, relatives in one case and "unknown" in six cases. Bruise and hematoma (80%) were the most common physical findings. Skull fractures were diagnosed in six cases, long bone fractures in two cases, hemoperitoneum in two cases, subdural hemorrhage in 10 cases, epidural hemorrhages in two cases, subarachnoidal hemorrhages in two cases, and retinal hemorrhages in five cases respectively. Seventeen cases required hospitalization and surgical operations performed were in nine cases. Four patients died and three patients had sequalae such as developmental delay and quadriplegia. Conclusion : Child abuse results in high mortality and morbidity in victims. Therefore early recognition and prevention is very important. Pediatricians should always suspect the possibilities of abuse in cases of fracture, intracranial hemorrhage, abdominal injury, or even any injury to the body. We recommend that the clinical investigation of suspicious children should include a full multidisciplinary social assessment, a skeletal survey and CT or MRI.
Keywords
Child abuse;
Citations & Related Records
Times Cited By KSCI : 2  (Citation Analysis)
연도 인용수 순위
1 Barnes PM, Norton CM, Dunstan FD, Kemp AM, Yates DW, Silbert JR. Abdominal injury due to child abuse. Lancet 2005;366:234-6   DOI   ScienceOn
2 Hobbs C, Childs AM, Wynne J, Livingston J, Seal A. Subdural haematoma and effusion in infancy:an epidermiological study. Arch Dis Child 2005;90:952-5   DOI   ScienceOn
3 Datta KS, Datta A. Recurrent intracranial hemorrhage in brain tumor. Indian Pediatr 2006;43:905-7
4 Lee Y, Lee KS, Hwang DH, Lee IJ, Kim HB, Lee JY. MR imaging of shaken baby syndrome manifested as chronic subdural hematoma. Korean J Radiol 2001;2:171-4   DOI
5 Kleinman PK, Marks SC Jr, Richmond JM, Blackbourne B. Inflicted skeletal injury:a postmorterm radiologic-histopathologic study in 31 infants. AJR 1995;165:647-50   DOI   ScienceOn
6 Oh CK, Lee MS, Park TK. A case of Battered child syndrome. Joong-Ang Medicine 1975;28:185-8
7 Choi JT, Ahn ME, Ahn HC, Choi YM, You KC, Cho YJ et al. Victims of child abuse to present to the Emergency Department. J Korean Emerg Med 1999;11:111-9   DOI
8 US Department of Health and Human service, National Center on Child Abuse and Neglect. Third national incidence study of child abuse and neglect. Final report Washington DC, US Gov. Printing office, 1996
9 Reece RM, Lugwig S. Child abuse:Medical diagnosis and management. 2nd ed. Philadelphia; Lippincott Williams & Wilkins, 2001
10 King J, Diefendorf D, Apthorp J, Negrete VF, Carlson M. Analysis of 429 fractures in 189 battered children. J Pediatr Orthop 1988;8:585-9
11 Kleinman PK, Nimkin K, Sperak MR, Rayder SM, Madansky DL, Shelton YA et al. Follow up skeletal surveys in suspected child abuse. AJR 1996;167:893-6   DOI   ScienceOn
12 Ameriacan Academy of Pediatrics, Section of Radiology. Diagnostic imaging of child abuse. Pediatrics 2000;105:1345- 8   DOI   ScienceOn
13 Belfer RA, Klein BL, Orr L. Use of the skeletal survey in the evaluation of child maltreatment. Am J Emerg Med 2001;19:122-4   DOI   ScienceOn
14 Kleinman PK, Marks SC Jr. A regional approach to the classic metaphyseal lesion in abused infants:the proximal tibia. AJR 1998;170:43-7   DOI   ScienceOn
15 Alexander R, Sato Y, Smith Y, Bennet T. Incidence of trauma with cranial injuries ascribed to shaking. Am J Dis Child 1990;144:724-6
16 Sugur NF, Taylor JA, Feldman KW. Bruises in infants and toddlers:Those who don't cruise rarely bruise. Arch Pediatr Adolesc Med 1999;153:399-403   DOI
17 Stoodley N. Neuroimaging in non-accidental head injury:if, when, why and how. Clinical Radiology 2005;60:22-30   DOI   ScienceOn
18 Caffey J. The whiplash shaken baby syndrome. Pediatrics 1974;54:396-403
19 Cicchetti D, Carlson V. Child Maltreatment:Theory and research on the causes and consequences of child abuse and neglect. Cambridge University Press 1995;135-57
20 A Report for Child abuse in Korea, 2001. Seoul, Ministry of Health and Welfare. 2002;a:1-25
21 Day F, Clegg S, Mcphillips M, Mok J. A retrospective case series of skeletal surveys in children with suspected nonaccidental injury. J Clin Forensic Med 2006;13:55-9   DOI   ScienceOn
22 Cooper A, Thomas T, Barlow B. Major blunt abdominal trauma due to child abuse. J Trauma 1998;28:1483-7   DOI
23 Guthkelch AN. Infantile subdural hematoma and its relationship to whiplash injuries. Br Med J 1971;2:430-1   DOI
24 Jeon HJ, Song YM, sShin MJ, Kang KC. A case of battered-child syndrome. J Korean Pediatr Soc 1979;22:61- 67
25 Worlock P, Stower M, Barbor P. Pattern of fractures in accidental and non-accidental injury in children:a comparative study. Br Med J 1986;293:100-2   DOI
26 Al-Mahroos F, Abdulla F, Kamal S, Al-Ansari A. Child abuse:Bahrain's experience. Child Abuse & Neglect 2005;29: 187-93   DOI   ScienceOn
27 Patricia GS, Bernard GE. Child deaths resulting from inflicted injuries:Household risk factors and perpetrator characteristics. Pediatrics 2005;116:687-93   DOI   ScienceOn
28 Barlow J, Stewart-Brown S. Child abuse and neglect. Lancet 2005:1750-2
29 Kim KI, Ko BJ. A Research of Battered child. Mental Health 1987;6:66-81
30 Prevent Child Abuse America. The total estimated cost of child abuse and neglect in the U.S.: Statistical evidence, The Edna McConnell Clark Foundation, 2001
31 Gaines BA, Shultz BS, Morrison K, Food HR. Duodenal injuries in children: Beware of child abuse. J Pediatr Surg 2004;39:600-2   DOI   ScienceOn
32 Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK. The battered-child syndrome. JAMA 1962;181:17-24   DOI   ScienceOn
33 Kleinman PK, Marks SC Jr, Blackbourne B. The metaphyseal lesion in abused infants:a radiologic-histopathologic study. AJR 1986;146:895-905   DOI   ScienceOn
34 Starling SP, Boos S. Core content for residency training in child abuse and neglect. Child maltreat 2003;8:239-241   DOI
35 Keshavarz R, Kawashima R, Low C. Child abuse and neglect presentations to a pediatric emergency department. J Emerg Med 2002;23;341-5   DOI   ScienceOn
36 Lonergan GJ, Baker AM, Morey MK, Boos SC. From the Archives of AFIP, Child abuse:radiologic-pathologic correlation. Radiographics 2003;23:811-45   DOI   ScienceOn
37 Yasuhide N. Child abuse and neglect in Japan. Pediatrics Int 2002;44:580-1   DOI   ScienceOn
38 Peck M, Priolo-Kapel D. Child abuse by burning:A review of the literature and an algorithm for medical investigation. J Trauma 2002;53:1013-22   DOI
39 Jayawant S, Rawlinson A, Gibbon F, Price J, Schulte J, Sharples P, et al. Subdural haemorrhages in infants: population based study. BMJ 1998;317:1558-61   DOI   ScienceOn