A 4-year-old boy presented with facial swelling and respiratory distress of 3-day duration. Mild cough and rhinorrhea were reported with no associated fever. On examination, facial swelling, engorged jugular veins, tachypnea, and subcostal retractions were noted. Furthermore, mild language delay was observed. Chest X-ray revealed right pleural effusion, and blood tests showed mild anemia and normal albumin level. Nephrotic syndrome and superior vena cava syndrome were initially suspected, but the history and physical findings were not consistent with the diagnoses. After removal of the child's clothes and diaper, complete physical examination showed unexplained wounds and scrotal ecchymosis (Fig. 1). Different stages of ecchymoses, including pink to red bleeding in the right inguinal area (normally immediately after injuries), blue discoloration over the right scrotum, dark purple discoloration over the left scrotum and lower penile shaft (usually 1–6 days after injuries), and yellowish discoloration in the lateral aspects of the scrotum (approximately 10–14 days after injuries), were observed. His mother attributed this to a fall at home 2 days ago; however, it was not credible because of the mixed old and new ecchymoses. After obtaining and exploring detailed history, it was found that the child was abused. His mother frequently battered him for his “poor temper” and irritable crying. Teeth extraction was also noted as a punishment for misdemeanors (Fig. 2). Child abuse, including physical mistreatment, sexual harassment, psychological violence, and neglect, remains a major public health and social welfare problem worldwide.1,2 The initial manifestations may be vague and protean ...
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", language="en", issn="1875-9572", doi="10.1016/j.pedneo.2019.12.005", url="http://dx.doi.org/10.1016/j.pedneo.2019.12.005" }