According to a report by Fox News Tuesday, bone specialists can be uniquely useful in detecting child abuse signs. This would help persons concerned with such accidents stand on facts against allegations of accidental mishaps that parents usually use to justify their kids’ injuries.
Following full text of report:
A corner fracture (circled) is a tell-tale sign of child abuse. It outlines a small bone chip at end of the child's femur, the signature marking of a "corner fracture." This type of leg fracture almost always results from child abuse, not injury, says Dr. David S. Feldman, chief of pediatric orthopedic surgery at the Hospital for Joint Diseases in New York.
More than 900,000 reports of child abuse were substantiated in 1998, and more than 2.8 million were reported, according to the Department of Health and Human Services, which released these new figures Monday in connection with this year's April observance of Child Abuse Prevention Month.
Surgeons like Dr. Feldman often find themselves on the front lines of child abuse prevention, as they can detect some of the hard-to-see signs.
"Orthopedic surgeons are uniquely positioned to identify a possible case of child abuse due to their specialized work with the musculoskeletal system," said Dr. James R. Kasser, orthopedic surgeon-in-chief at Children's Hospital in Boston
DETECTING DANGER
When a child comes into the hospital with a broken bone, parents or family members may explain away a child's injuries with stories of an accident. How can an orthopedic specialist determine when this "accident" is really physical abuse?
If X-rays indicate a child has different fractures in different stages of healing, "this would absolutely indicate abuse," Feldman said.
"Several fractures at different stages of healing are seen in 70 percent of abused children less than one year old and more than 50 percent of all abused children," noted Kasser.
Even if the injury for which the child is being brought to the emergency room is accidental, it is almost impossible for multiple fractures at different times to happen by accident.
CERTAIN KINDS OF FRACTURES ALSO RAISE SUSPICIONS OF ABUSE
The bone fleck of a corner fracture indicates that a sliver of bone has been broken off - an injury that occurs when a child's leg is twisted, Feldman said. This long, thin fracture is not the sort of injury that would result from a single, accidental impact.
Multiple fractures of the posterior rib bones often show that a child has been squeezed too hard.
When doctors see a fracture in the long bones of the arms and legs in a young child who cannot walk, this raises a red flag. These bones, used in locomotion, are usually broken through falling down; a child who is crawling cannot fall down.
If doctors see these signs, they will ask the child to undress from head to toe and carefully examine the child for other "soft signs" of abuse, such as bruising on the buttocks, iron marks or cigarette burns on the arms or legs.
Talking to the Parents
In most cases, the doctors will ask the parents or caregivers what happened, as it is possible that the child may have been set on a chair or sofa, and fallen off, or the parent may have tripped over a dog or a toy while carrying the child.
"Often times, you won't call the authorities if the parents have a reasonable story," Feldman said. "You don't want to become a detective."
But sometimes the story does not add up, and the signs of abuse are clearly there. In this case, doctors are legally required to report the abuse to the child protective services and the department of social services.
Though the exact procedure varies from state to state, the doctor who cares for the child carries the responsibility in all cases for reporting the abuse and cannot be overruled by a supervisor.
The parents must also be notified. "What I say is something like 'I am not accusing you, but your excuses aren't great. There is clearly evidence that something is going wrong,'" Feldman noted.
The physician cannot be sued or prosecuted for reporting abuse. But the failure to report or detect abuse does have its consequences.
Failure to diagnose child abuse after the first injury, Kasser said, "may result in a 30 to 50 percent chance of repeated abuse and a five to ten percent chance of death." – Albawaba.com
© 2000 Al Bawaba (www.albawaba.com)
