Child-related risk factors and injuries in cases of physical child abuse

Abstract

Background

When evaluating child welfare risk, recognition of abuse-related injuries and knowledge of risk factors for child abuse are important aspects. The purpose of this study was to evaluate child-related risk factors and particularities of injuries in cases of physical child abuse, to use the results for preventive child protection. Methods

This retrospective case control study evaluated case files of 368 physically abused children (age range 0–14 years) referred to forensic medicine in 2004–2015. Death cases and cases that could not be separated from sexual abuse and neglect were excluded and 363 controls without suspicion of abuse were recruited from a pediatric clinic. Demographic data, state of care and previous illnesses were compared in both groups by determining χ2-test and Fisher’s exact test. Concerning injuries, specified mechanism of origin, type of violence, localization on the body and frequency of life-threatening and repeated abuse were evaluated. Results

Male gender and age group of infants/toddlers were identified as significant child-related risk factors. In over 90%, injuries resulted from blunt trauma, with the skin (86%) and skeletal system (22%) most commonly involved. Injuries were located in almost 60% on obvious parts of the body. Reported causes for trauma were mostly accident mechanisms. Repeated abuse was found in over half and life-threatening injuries in nearly 20% of the cases. Conclusion

As part of the daily work pediatricians and other child protection workers are able to identify suspected cases early. Therefore, good understanding of typical risk factors and injuries including plausibility check of the reported origin are important aspects. Periodic reassessment of child well-being and mandatory visit to pediatricians could avoid repeated and severe child maltreatment with life-threatening consequences.