Citation

Berthold O, Frericks B, John T, Clemens V, Fegert JM, Moers AV. Dtsch. Arztebl. Int. 2018; 115(46): 769-775.

Affiliation

DRK Kliniken Berlin | Westend, Department of Pediatrics, Child Protection Outpatient Clinic; DRK Kliniken Berlin | Westend, Department of Diagnostic and Interventional Radiology; DRK Kliniken Berlin | Westend, Department of Trauma Surgery and Orthopedics; Department of Child and Adolescent Psychiatry/Psychotherapy.

Copyright

(Copyright © 2018, Deutscher Ärzte-Verlag)

DOI

10.3238/arztebl.2018.0769

PMID

30602409

Abstract

BACKGROUND: It is well known that physical abuse of children all too often escapes detection. Fractures are among the potential consequences of physical abuse but are also com- mon in childhood because of accidents. A question frequently addressed to the Medical Child Protection Hotline (Medizini- sche Kinderschutzhotline) is how fractures due to abuse can be distinguished from accidental fractures.

METHODS: This review is based on pertinent publications retrieved by a search in PubMed and in the Cochrane Data- base, as well as on the authors' experience in a pediatric emergency department with ca. 29 000 consultations per year and in a child protection outpatient clinic with ca. 100 consultations per year.

RESULTS: Fractures due to abuse are especially common among infants; their incidence is estimated at 56.8/100 000 among infants less than six months old and 39.8/100 000 among infants aged 6 to 11 months. In consideration of the age of the child, the type of fracture, the history, and other factors, a high probability of abuse can be suspected in many cases, so that further measures can be initiated.

CONCLUSION: All physicians involved in the care of children (even if only occasionally) should be aware of the major indicators of likely physical abuse and of the available oppor- tunities for counseling and intervention. Failures to diagnose child abuse are associated with high rates of recurrence and mortality.

Language: en