Abuse

When to suspect abuse

• Suspect in atypical, pediatrics, elderly
  • Absent or vague explanation, inconsistent story, history non-compatible with injury
  • Delay in seeking medical attention
  • Lesion/explanation non-compatible with child's age (eg. younger than 10 months with bruises, bruises on abdomen/thorax/buttocks, fractures in non-ambulatory children)
  • Failure to thrive, dental caries
  • Metaphysis fracture (bucket handle)
  • Posteromedial rib fractures
  • Fracture of different ages
  • Shaken-baby syndrome (subdural hematoma, cerebral edema, retinal hemorrhages)
  • Apathy of caregiver/patient
  • Geometric lesions