Vital Signs Volume 8, Issue 1 | Page 3

Keeping Our Children Safe The blue ribbon is recognized as the national symbol of child abuse awareness. What are recognizable signs of child abuse – in infants, toddlers and older children? Dr. Wright: Any bruise in an infant who is not mobile is abnormal and highly suspicious of child abuse. The child should undergo a thorough medical evaluation. Children who don’t cruise – certainly those 4 months and younger – rarely bruise. The bruising can be very subtle. For children 4 years and younger, any bruise to the torso, ears or neck also needs to be fully evaluated for an abusive situation. Those are not normal bruises, unlike bruises to the shin or forehead in children who are walking and playing. In addition, our suspicion rises when a child is vomiting but doesn’t have a fever, diarrhea or some other medical ailment. Sometimes that can indicate that there’s been some head trauma. Behavior changes can also be a sign of abuse. If your son or daughter suddenly becomes more withdrawn or fearful of some individual, that needs to be investigated as well. What is shaken baby syndrome, or abusive head trauma? Dr. Wright: It usually occurs when a baby’s crying is unconsolable and frustration rises to the point where the child is picked up and physically shaken back and forth. The neck muscles of babies are not very well-developed, so the head will literally flop back and forth. It can occur with as few as three rapid shakes. When the shaking starts, the brain bounces against the bony structures inside the head. It can cause bleeding to the brain tissue and can lead to serious damage or death. Often, those children will also have fractured ribs. Another result could be bleeding in the eye that could cause damage or even blindness. Abusive head trauma can have life and death implications. What kinds of injuries lead to death or near-death? Dr. Wright: Most of the injuries involving fatalities are injuries to the brain, whether it’s shaken baby or blunt force trauma in which the child is hit in the head. The child could be thrown up against a wall or thrown down on the floor. Such trauma does the most damage and is F