September Week 3: Nonaccidental Trauma

Article 1:
Fugiwara, Takeo, Makiko Okuyama, and Mikiko Miyasaka. “Characteristics That Distinguish Abusive From Nonabusive Head Trauma Among Young Children Who Underwent Head Computed Tomography in Japan.” PEDIATRICS 122.4 (2008): 841-47. 

Case 1:
You are seeing a four month old girl on your ER rotation who is coming in for increased fussiness and decreased desire to feed. Her mom reports that her caretaker placed her on a bed, 2 feet from the floor, and the child rolled off while her back was turned. The incident was not witnessed. CT of the head reveals a subdural hematoma.

What are some general risk factors for abuse? 
What is the clinical definition of Abusive Head Truama (AHT)?
What clinical signs are more common with AHT then with non-AHT?
What next study would be important to obtain if you suspect AHT?

Article 2: Asnes, Andrea G., M.D., and John M. Leventhal, M.D. “Managing Child Abuse.” Pediatrics in Review 31.2 (2010): 47-55. 

Case 2:
An 18 month old boy presents to you in the ER accompanied by his mother with the chief complaint of refusal to walk. Mom states that the child has just returned from a visit at his father’s house where he is cared for by his father and his girlfriend. No accidents were reported. Xray in the ER revealed a nondisplaced spiral fracture of the distal tibia.

Are practitioners required to report suspected abuse? 
When should you report suspected abuse, immediately upon suspicion or after all data has been obtained? 
Where do pediatric practitioners report abuse?
Who are mandatory reporters in the community? 
What happens when CPS decides that a child’s safety is in imminent danger because of abuse or neglect?