Jun 06

Be Human Stop Child Abuse : Vol 18, 5th June, 2013


1. Approximately 90% of child victims of abuse do not show evidence of physical damage. These were found in less than 10% of abused children. Physical signs of abuse often are difficult to recognize and should not be the only indicators (Forensic Sci Int. 2012 Apr 10;217(1-3):1-4.)

2. The prevalence of clear evidence of sexual assault in the U.S. ranges from 3-23%, in Italy 9.5%, in Thailand 32% and in Denmark 40%. In Israel, as elsewhere in the world, few cases of sexual assault in children will have clear evidence of a sexual nature.

A lack of physical evidence does not rule out sexual assault, therefore, finding physical evidence during an examination is the exception rather than rule. Questioning the victim and investigating the circumstances of the case are crucial elements in all instances of presumed sexual assault on children. (Harefuah. 2011 Dec;150(12):895-8, 936.)





Dr Vinay Aggarwal, President, Elect CMAAO

Dr K Vijayakumar (National President) IMA

Dr N Saini (Secretary General) IMA

Dr M Pillai (Chairman Organising Committee)

Dr D R Rai (Organising Secretary)

Dr S Arulrhaj (Chairman Scientific Committee)

Dr KK Aggarwal (Co-Chairman & Editor)

Dr Good Dr Bad

Situation: A child brought by the police suspected of being physically abused had bluish spots on lower back and legs.

Dr. Bad: It is a clinical bruise suggestive of physical abuse.

Dr. Good: It is a Mongolian spot.

Lesson: Mongolian spots are bluish-gray areas of skin discoloration. They normally disappear by one year but may persist into adulthood. They are seen most commonly on the buttocks and also lower back but may also be seen on the legs, shoulders, upper arms and scalp. At first glance they are often confused with fresh bruising but they do not change color as do bruises and fade over months to years rather than days.

Situation : A child with fractures of both wrists and forearms was brought by police to rule out physical abuse by parents.

Dr. Bad: Fracture at age 3 in children always means physical abuse.

Dr. Good: This appears to be a case of brittle bones.

Lesson:: Before labeling a patient as a case of physical abuse, always look for metabolic congenital anomalies as a cause of repeated fractures.

Situation : A patient with blisters was alleged by police to be a case of physical abuse by parents.

Dr. Bad: It is a case of physical abuse.

Dr. Good: This looks like phytophotodermatitis.

Lesson: Phytophotodermatitis is a condition with blister-like skin lesions that occur when sunlight interacts with photosynthesizing compound found in certain fruits, vegetables or fragrance products. The lesions may appear in unusual patterns of streaks and, sometimes, as fingerprints or handprints, which may be mistaken for child abuse.

Situation : A child with bullae was brought by police as a case of suspected physical abuse.

Dr. Bad: This is a case of physical abuse.

Dr. Good: This is due to reaction of garlic.

Lesson: Garlic application to the skin of infants as a naturopathy remedy can cause bullae and partial thickness burns.

Situation : A child with multiple skin lesions was brought to evaluate physical abuse.

Dr. Bad: This is a case of physical abuse.

Dr. Good: This is because of cupping.

Lesson: Cupping is a therapeutic technique practiced in complementary medicine. In cupping, the air in an open mouthed vessel is heated by various means and then the vessel is applied to the skin. The suction force created by cooling and contracting of a heated area is thought to draw out the ailments. The heated air and the rim of the cup can burn the skin. Cupping injury presents as a circular burn usually on the back. Central ecchymosis and or petechiae result from the suction affect of the heated air as it cools and contact.

Readers Response
  1. Dear Sir, Nice updates. Regards:Dr Shantanu

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