Unquestionably, child abuse is one of the most devastating and horrendous issues faced by health practitioners. Not only because of the vulnerability of the victim and the implications for their future health but also because of the senselessness of this violence.

In a BMJ editorial, Naomi Sugar explains current research and makes a case for putting money towards the research needed to refine the medical field’s understanding of child abuse.

Sugar first notes that the importance of diagnosing child abuse is a solemn affair. Making a diagnosis of this sort can break up families, put people in jail, and is, of course, a black mark on personal reputations. Unfortunately though, diagnosing child abuse is not a cut and dry affair.

Currently several factors are examined when child abuse is considered:

• A physical examination
• A radiological survey
• Caregiver’s report of the accident
• Reports of the scene from those present soon after the injury occurred
• History from other observers

Even with these considerations, determining abuse can still be difficult although there are several red flags that practitioners pay attention to. One such case is when caregiver’s change the event details from retelling to retelling. Another is when the present injury is not connected to the events being described.

Sugar reviews a Welsh study on child abuse. This study notes that most times abuse is diagnosed when the abuse is out-and-out admitted or when the abuse is confirmed through a variety of means such as case meetings or court proceedings.

This Welsh group has studied numerous types of child abuse injuries including scald burns, human bites, oral injuries, bruises, and, in this current study, fractures. This group and others who study child abuse use a number of techniques such as computer modeling, documented case studies, autopsy studies, and retrospective case reviews to develop a more precise understanding of these injuries. Researchers use a variety of tools to represent actual humans. Cadaveric rabbit models and test dummies are two such tools.

Sugar notes that uniformity of observational studies of infant and toddler fractures will help further understanding of child abuse injuries. She suggests that these studies need “age categories, uniformly applied diagnostic procedures, such as skeletal surveys, and a priori diagnostic criteria for abuse and non-abuse.”

Increasing the accurate diagnosis of child abuse is necessary in order to ensure both the safety of children and the integrity of the family unit. New techniques and improved methodology will lead the way towards making this a reality.

Reference

N. F Sugar (2008). Diagnosing child abuse BMJ, 337 (oct02 1) DOI: 10.1136/bmj.a1398

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