Authors: Fiona Mendes / Editor: Yasmin Sultan / Reviewer: Fiona Mendes / Codes: / Published: 15/12/2022
During the pandemic there has been a heightened vulnerability of children to child abuse. Refresh your knowledge with this SAQ.
A 5-year-old girl is brought by her young mother to your Paediatric Emergency Department (ED) at 03:20 after she complained she could not sleep due to a headache, which her mother attributes to her daughter falling down the stairs at home three days ago. It was an unwitnessed fall and when asked, the child glances at her mother and tells you that she cant remember what happened. Apart from the headache, the child seemed well after the fall, so they did not seek medical attention.
Her mother is fashionably dressed and smells strongly of marijuana and alcohol. When questioned, the mother becomes agitated, denies alcohol and substance misuse and says the smell is because she went to a club after work yesterday and the smell from the bar has soaked into (her) jacket. She seems distracted and is sending messages on her phone during the consultation.
The child is quiet, appears anxious and reluctant to interact with you. She looks to her mother when you ask questions. She tells you that her headache has resolved.
On examination of the child, she appears underweight and under her stained clothes you observe several bruises of different shapes and sizes on her arms, legs, shoulders and back with dark blue, purple, green and yellow pigments. The girl and her mother tell you that bruises are from running and falling as she is active and has always been very clumsy.
Neurological examination is normal. There is no evidence of external head injury.
When you review this childs ED notes, you note that she has attended your ED twelve times over the past year for previous limb injuries, minor fractures and superficial burns. Her sibling was previously known to social services and the case was closed. As you are reading this, the mother bursts out of the cubicle and says she cannot wait and that she just wanted her daughter checked but now feels everything is all fine so they will both go home now.
You suspect that this childs presentation may have resulted from an inflicted, non-accidental injury.
