Child Abuse Has Unfortunately Been

Child Abuse has unfortunately been a part of society from the earliest times. Children in Ancient Rome were killed if they were deformed, disabled or of the wrong gender. Until recent history, some parents were still killing their female infants in China. During the Industrial Revolution, children worked long hours in horrible conditions. In parts of the world, this still takes place.

Child abuse still occurs in alarming numbers in the U.S., how many for sure is unknown since most abuse and neglect goes unaccounted

Reports of child abuse are increasing as healthcare providers gain experience in recognizing the signs and symptoms of physical or mental harm. Anyone involved in the care of children is likely to see youths who have been physically abused..

Although it is understood that abuse occurs in all socio-economic and educational strata and religions, certain children are more at risk than others. Most abused children are three or younger; the numbers abused decreases with age. Certain behaviors and problems in infants and toddlers precipitate anger, such as constant crying, developmental delays that keep the child from meeting expectations, behavior problems and medical conditions. Such risk factors should not be considered alone when determining possibility of abuse, but rather along with other concerns.

The Federal Child Abuse Prevention and Treatment Act (CAPTA), (42 U.S.C.A. 5106g), as amended by the Keeping Children and Families Safe Act of 2003, defines child abuse and neglect as, at minimum as 1) Any recent act or failure to act on the part of a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse or exploitation; or 2) An act or failure to act that presents an imminent risk of serious harm. Neglect includes medical, educational, emotional and physical. Physical abuse consists of any injury from minor bruises to severe fractures or death as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting burning, or otherwise harming a child. Such injury is considered abuse regardless of intent. Abuse also includes sexual activities and emotional harm. Child abuse is also normally repetitive and escalates over time.

When a healthcare provider sees a child with a physical injury, it is necessary to take a complete history from the parent or caregiver. This includes a timeline with the amount of delay between the injury and its reporting, who was with the child at the time, and who was a witness. If possible, depending on the child's age and level of understanding, he/she should be questioned on how the injury took place. At this time, the healthcare provider should be looking for specific signs such as tissue damage and redness. It is also necessary to take a complete medical history; a family tree of the immediate members as well as previous health problems is helpful.

If abuse is suspected, then the child must receive a complete physical examination, with all indications completely written down and explained and photographs and drawings included. Bruises are the most common injury; the pattern, shape and location should be noted, because certain instruments such as belt or hanger will make a specific mark on the body. Those over boney areas such as the knee and elbow are frequently accidental. Areas that are in protected and padded areas, such as the face ad buttocks, should be of concern. Lacerations and coloring will give an indication of timing. Blood clotting time and platelet count should be ordered to rule out other reasons for bruising.

Bite marks are a concern due to infection, and if they are caused by an animal or a human (child or adult). The most common cause of burns is scalding from hot liquid. About 10 to 25% of all burns are abuse, and most occur in children under three. Again, pattern, location and characteristics must be noted. Accidental burns normally leave an irregular pattern on the face, hands and trunk due to splashes. Other burns, such as those that are uniform, are more suspect of emersion or purposeful scalding. Cigarette burns are also common, because the child may accidentally come in contact with the lit end. A more pronounced and deeper burn is indicative of purposeful cigarette burns.

It is essential for the healthcare provider to keep in mind that there are mimickers of child physical abuse. For example, Mongolian spots, most often seen in black, Arab, Latino and American Indian babies, are blue-green areas of pigmentation normally on the buttocks. These can be taken for bruises. The child should be reassessed in a week, if necessary. Erythema multiforme minor is caused by a reaction to drugs or infections. These lesions can also be mistaken for abuse.