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National Child Abuse Prevention Month Stirs Awareness

April 14, 2010
Written by: , Filed in: Medical Ethics
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Part 1 of 2

“Radiologic examination is the mainstay for diagnosing physical abuse in children.”

This quote in emedicine from a paper by lead author Avneesh Chhabra, MD, staff radiologist at the Drexel University College of Medicine in Philadelphia both harkens back and proclaims forward and is especially significant during April, National Child Abuse Prevention Month.

Dr. Chhabra remembers John Patrick Caffey, MD, “the father of pediatric radiology,”  and his “landmark article of 1946 [which] noted an association between healing long-bone fractures and chronic subdural hematomas in infancy, and it was the first to draw attention to physical abuse as a unifying etiology. In 1962, Caffey and Kempe et al proposed manhandling and violent shaking as mechanisms of injury and emphasized the acute and long-term sequelae of abuse as serious public health problems.”

Calling on all subspecialties of radiology to watch for the signs of abuse, Dr. Chhabra reiterates the risk factors: physical disability, prematurity, low birth weight and low socioeconomic level. Children who are stepchildren or who are twins are also more likely to be abused. And the younger the child, the greater the chance of risk. The bulk of abuse related deaths occur in babies who are less than one year old. Girls are more likely to be abused than boys, but only by a slight ratio.

Prior to or after imaging, physicians are reminded to look for other clues. The abused child may be withdrawn and may be hesitant to show their bruises, which may be multiple and not in the usual places of knees and elbows. Eye or head injuries may be particularly telling.  

“The radiologist may be the first to raise a question of abuse if characteristic or unexplained findings are encountered during imaging,” Dr. Chhabra wrote. “Immediate, direct communication with the referring physician is imperative in such cases.”

Related seminar: Interventional Radiology Review

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