Review Question - QID 100005

The child described in the question stem is suffering from child abuse. The next appropriate step in the car of this patient is to contact child protective services.

Physical evidence of child abuse includes healed fractures on X-ray, subdural hematomas, multiple bruises, and retinal hemorrhage or detachment. Retinal hemorrhages are highly associated with shaken baby syndrome. and child abuse. Children may also present with cutaneous findings, such as cigarette burns. A thorough examination may reveal injuries of varying ages.

McDonald reviewed the approach and management to patients suffering from suspected child abuse. Any suspicion of abuse must be reported to Child Protective Services.

Banaszkiewicz et al. performed a retrospective review over a five year period on children < 1 year of age who presented to the ER with a fracture. They found that 28% of the time, abuse was underestimated at the time of evaluation. Subsequently, they recommend admitting all patients in this age group with any fracture and consulting child protection services.

Figure A displays retinal hemorrhages.

Incorrect answers:
Answer 1: Vitamin C deficiency causes the disease scurvy, which is characterized by swollen gums, bruising, and hemarthrosis.
Answer 2: Osteogenesis imperfecta is a genetic deficiency of type I collagen that results in "brittle bones." The frequent fractures of OI can be mistaken for child abuse. Note that OI presents with blue-appearing sclera, not blue irises. Furthermore retinal hemorrhage makes child abuse more likely in this case.
Answer 4: Hearing loss commonly experienced by OI patients. A hearing test would not be indicated in this patient as child abuse is much more likely than OI in this scenario.
Answer 5: Bone marrow transplant would be indicated if the patient was suffering from leukemia. Easy bruising is a common presentation of leukemia in the pediatric population. However, leukemia would not explain the multiple fractures or retinal hemorrhages.