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Physical Abuse of Children / Non-Accidental Injuries

Statistics show that more than half the victims of child abuse have fractures. The orthopedic surgeon will often be the first person to identify a potentially abused child. 

The safest pathway for the child and clinician is to make a child abuse report in all suspicious cases.

Risk Factors for Child Abuse

  • single parent household, particularly father-only households

  • Household income does not relate to increase risk

Medical History

  • (1) Who witnessed the event? 

    • Child abuse is unusual in a group setting. If, by history, multiple adults witnessed the event, it is more likely to be accidental, and it is easy to verify the history. 

    • If possible, the adult witnesses should be interviewed separately. 

  • (2) Was there a delay in seeking medical care? 

    • Child abusers tend to delay seeking care for their injured children. 

  • (3) Is the history plausible? 

  • (4) What is the mechanism of injury? 

    • Does  the parent's story fits that mechanism 

  • (5) Does the history change over time? 

    • Parents who have abused their children may modify the medical history over time. 

  • (6)  History of failure to thrive

  • (7) previous unusual injury (eg, fractured femur in a child 6 months of age)

  • (8) A history of a serious high-risk injury or unexplained death in a sibling

  • (9) Missed immunizations

  • (10) Lack of medical records

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