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WHICH INJURIES TO INFANTS SHOULD RAISE SUSPICIONS OF ABUSE?

Trauma to children under one year of age is a common and important problem. One of the difficulties faced by clinicians is sorting out injuries due to abuse from the larger group of accidental, unintentional injuries. Rivara and colleagues conducted a study to describe the circumstances and characteristics of injuries in children under one year old treated in the emergency room, and to compare unintentional injuries with those due to abuse.

There were 146 infants in the unintentionally injured group and 45 in the abused group. Unintentional injuries were seen 15 times more frequently than injuries due to abuse. The majority of unintentional injuries were minor, although skull fractures occurred in eight children and fractures of the clavicle in seven. In contrast, injuries from abuse were most often multiple and severe and were more likely to lead to long-term disability. Fractures of the ribs and lower extremities and retinal hemorrhages were seen only in the abused group. There were no differences between the two groups in the reported time of day when the injury occurred or when care was sought.

This study indicates that serious injuries in infants are rarely due to unintentional trauma. Certain kinds of injuries (such as severe closed head injury, rib fractures, abdominal injuries, and retinal hemorrhages) should be viewed as potential signs of abuse.

— PMM

Published in Journal Watch General Medicine January 29, 1988

Citation(s):

Rivara F P; Kamitsuka M D; Quan L. Injuries to children younger than 1 year of age. Pediatrics 1988 Jan 81 93-97.

• Medline abstract (Free)