Trauma from child abuse

Caffey and Kempe first focused the medical community's attention on the problem of child abuse by identifying an association between long bone fractures and subdural hematomas in children. Further work led to Kempe's symposium and article ‘‘The Battered Child Syndrome’’ (1–3). As awareness increased, it became clear that a constellation of injuries is associated with child abuse and that these injuries occur in patterns. Because the history is often unreliable or deliberately deceptive, the recognition of known patterns of injury and the judicious use of diagnostic imaging are important in the evaluation of these patients. Unfortunately, prospective, randomized, controlled trial data on child abuse are unavailable. Since the treatment of most of the injuries associated with child abuse is well described elsewhere in this and other texts, this chapter will not review the treatment of specific injuries. Instead, it will attempt to assist the practitioner in deciding whether identified injuries could be caused by the reported mechanism and in recognizing the unique associations that have been previously identified.