Risk Factors for Physical Child Abuse in Infants and Toddlers

Abstract

Background: We examined the risk factors and injuries in physical child abuse between November 2003 and February 2007. Patients and Methods: The uptake area of the University Hospital of Turku, Finland, consists of about 700 000 inhabitants. Forty-eight cases of physical child abuse were examined. The median age of the abused children was 2.2 years, for children with skull fractures it was 0.5 years. The incidence of child physical abuse increased during the study period; it was 0.6/month in 2004 and 1.7/month in 2006. Mortality in the study group was 2.1 %. Results: Depression, overactivity, crying and prematurity were risk factors in the physically abused children. Parental risk factors were alcohol and drug abuse. Most often the perpetrator was the father or stepfather; when the perpetrator was unknown, the children were mostly in their mothers' care. The average delay of 3 weeks until starting the investigation into abuse was mostly due to delays by health centers or homes. Radiographs were the cornerstones of the medical examination but magnetic resonance examinations were essential for the examination protocol. Conclusions: All levels of public health services, day care facilities and schools must be aware of possible physical child abuse and initiate an investigation as soon as possible by contacting the authorities. Physically abused children and their families must be followed up and supported for a sufficiently long period by social pediatric outpatient wards. The general information on child maltreatment provided to the public needs to be increased to prevent abuse. A child welfare report must be made to social workers in every maltreatment case examined in hospital, and in most cases the offence must also be reported to the police. Nevertheless, in certain cases even permanent custody of the child cannot be avoided.

Key words

physical abuse - maltreatment - skull fracture - intracranial hematoma

References

• 1 Altemeier W A. Interpreting bruises in children.  Paediatric Annals. 2001;  30 517-520
• 2 Banaszkiewicz P A, Scotland T R, Myerscough E J. Fractures in children younger than age 1 year: importance of collaboration with child protection services.  J Pediatr Orthop. 2002;  22 740-744
• 3 Barlow K, Thompson E, Johnson D. The neurological outcome of non-accidental head injury.  Pediatr Rehabil. 2004;  7 195-203
• 4 Barlow K M, Thompson E, Johnson D. et al . Late neurological and cognitive sequelae of inflicted traumatic brain injury in infancy.  Paediatrics. 2005;  116 174-185
• 5 Bays J. Conditions mistaken for child physical abuse. Reece RM, ed. Child abuse. Medical diagnosis and management. Philadelphia; Lippincott Williams & Wilkins 2001: 177-206
• 6 Beers S, De Bellis M. Neuropsychological function in children with maltreatment-related posttraumatic stress disorder.  Am J Psychiatry. 2002;  159 483-486
• 7 Blumenthal I. Skull fracture – child abuse or an accident?.  Lancet. 2000;  356 258
• 8 Fagan A A. The relationship between adolescent physical abuse and criminal offending: support for an enduring and generalized cycle of violence.  J Family Violence. 2005;  20 279-290
• 9 Helfer R E, Slovis T L, Black M. Injuries resulting when small children fall out of bed.  Paediatrics. 1977;  60 533-535
• 10 Howells N L, Rosenbaum A. Effects of perpetrator and victim gender on negative outcomes of family violence.  J Family Violence. 2008;  23 203-209
• 11 Jenny C, Hymel K P, Ritzen A. Analysis of missed cases of abusive head trauma.  JAMA. 1999;  281 621-626
• 12 Kairys S W, Alexander R C, Block R W. et al . Shaken baby syndrome: rotational cranial injuries – technical report.  Paediatrics. 2001;  108 206-210
• 13 Larrivée M C, Tourigny M, Bouchard C. Child physical abuse with and without other forms of maltreatment: dysfunctionality versus dysnormality.  Child Maltreat. 2007;  12 303-313
• 14 LeFanu J, Edwards, Brown R. Subdural and retinal haemorrhages are not necessarily signs of abuse.  BMJ. 2004;  328 767
• 15 Lyons T, Oates K. Falling out of bed: a relatively benign occurrence.  Paediatrics. 1993;  92 125-127
• 16 Maas C, Herrenkohl T I, Sousa C. Review of research on child maltreatment and violence in youth.  Trauma Violence Abuse. 2008;  9 56-67
• 17 Miller M E. The lessons of temporary brittle bone disease: all bones are not created equal.  Bone. 2003;  33 466-474
• 18 Reece R M, Nicholson C, eds. Inflicted childhood neurotrauma. Bethesda, MD; American Academy of Pediatrics 2003
• 19 Starling S P, Sirotnak A P, Heisler K W. et al . Inflicted skeletal trauma: the relationship of perpetrators to their victims.  Child Abuse Negl. 2007;  31 993-999
• 20 Sunday S, Labruna V, Kaplan S. et al . Physical abuse during adolescence: gender differences in the adolescents' perceptions of family functioning and parenting.  Child Abuse Negl. 2008;  32 5-18
• 21 Tenney-Soiero R, Wilson C. An update on child abuse and neglect.  Curr Opin Pediatr. 2004;  16 233-237
• 22 Thomas N J, Shaffer M L, Rzucidlo S. et al . Temporal factors and incidence of physical abuse in young children: decreased non-accidental trauma during child abuse prevention month.  J Pediatr Surg. 2007;  42 1735-1739
• 23 Trenchs V, Curxoy A I, Navarro R. et al . Subdural haematomas and physical abuse in the first two years of life.  Pediatr Neurosurg. 2007;  43 352-357
• 24 Vinchon M, Defoort-Dhellemmes S, Desurmont M. et al . Accidental and nonaccidental head injuries in infants: a prospective study.  J Neurosurg. 2005;  102 380-384
• 25 Whitby E H, Griffiths P D, Rutter S. Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors.  Lancet. 2004;  363 846-851
• 26 Williams R. Injuries in infants and small children resulting from witnessed and corroborated free falls.  J Trauma. 1991;  31 1353-1355
• 27 Wu S S, Ma C X, Cartel L L. Risk factors for infant treatment: a population-based study.  Child Abuse Negl. 2004;  28 1253-1264
• 28 Zenel J, Goldstein B. Child abuse in the pediatric care unit.  Crit Care Med. 2002;  30 S513-S523