By Christina Orlovsky, contributor
April 9, 2010 - April marks national Child Abuse Prevention Month, a time of increased awareness and education about abuse and neglect, advocacy for organizations that work to prevent atrocities against children, and support for the innocent victims who are too young to protect themselves. Health care professionals are in a unique position in which they may be able to identify signs of abuse that are often hidden from the naked eye, thanks to diagnostic imaging that can identify abuse-related injuries.
“X-rays, bone surveys and CT scans are very easy ways to detect abuse,” explains Demetra Soter, M.D., a pediatrician at John H. Stroger Jr. Hospital of Cook County, in Chicago, Ill. “I love radiology and x-rays—I think they save children’s lives.”
According to Diagnostic Imaging of Child Abuse, a guide published by the U.S. Department of Justice’s Office of Juvenile Justice and Delinquency Prevention, there are several types of injuries that can be identified through diagnostic imaging modalities such as x-ray, bone scans, CT scan, MRI and ultrasound: skeletal injuries, intracranial injuries, thoracoabdominal trauma (injury to the chest or abdomen) and Shaken Baby Syndrome. For skeletal injuries, x-rays are the most useful in detecting abuse in infants and children younger than two years of age, while CT has proven beneficial in identifying injury to organs.
Soter points to the use of x-ray and bone scans to identify injury to other bones, as well.
“As an example, you have a two-year-old come in not moving his arm and he can’t tell you what’s wrong. If you do an x-ray and it shows a break, it shows you something is going on,” she says. “Now, if it’s a toddler fracture to a small bone in the bottom of the leg, that might be an accident; but if it’s a huge bone like the humorous, the third-largest bone in the body, that’s suspicious.”
She adds that while diagnostic imaging is not always conclusive, it is often evidence enough to report on behalf of young patients for signs of possible abuse or neglect.
“If you do an x-ray and find other fractures—and the story or history doesn’t fit—it’s clearly abuse or bone disease,” she says. “It’s not 100 percent, but it helps tremendously.”
Cindy W. Christian, M.D., director of Safe Place: The Center for Child Protection and Health at the Children’s Hospital of Philadelphia in Pennsylvania, and the chair of the American Academy of Pediatrics (AAP) section on child abuse and neglect, adds that testing is just one essential part of an overall investigation.
“Radiologic imaging is an important tool for identifying abused children, although the yield from various radiologic studies varies by age and clinical scenario,” she said. “In some cases, the imaging alone can identify an abused child, for example if there are multiple injuries to different organ systems. Sometimes injuries are identified by imaging, but the injury is non-specific, and the clinical history and other tests are needed to evaluate the child.”
Finally, Soter adds that while diagnostic imaging is one critical way to detect child abuse, nurses play an equally important role in protecting their young patients.
“Nurses are so much better than doctors at figuring out child abuse,” she says. “They see the parents and how the family is acting, and they often have better interpersonal skills—they’re the child’s biggest advocate.”
She concludes that if nurses suspect a patient is being abused, they should stick to their guns and do something about it.
“The first thing is to never allow a doctor to talk them out of what’s right,” she says. “If they’re suspicious, they need to report it.”
Christian agrees: “Health care workers need to review growth parameters, and always consider the possibility of abuse in children with injury,” she says. “Only a small minority of injuries in children are due to abuse, but when the history provided does not fit with the identified injuries, when there are multiple injuries to different organ systems, or when there are other concerns, the provider should consider abuse, obtain consultation from colleagues if there are questions, and remember that health care providers are mandatory reporters of suspected abuse to child welfare agencies.”
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