Maltreatment of children may involve physical, emotional, or sexual abuse or neglect. It is too common with an incidence of 9.1/1,000 children. Although there are family- and child-related factors associated with abuse and any age child can be abused, it is the younger infant and child who are most commonly at risk. Early infancy, when crying peaks, is a time of increased risk of abuse and especially abusive head trauma. The diagnosis of non-accidental trauma is based on a detailed history of the injury with documentation of the precise mechanism as reported by the caregiver. The injuries must have an explanation with a plausible mechanism for how they occurred. All states have reporting laws for suspected abuse and provide a degree of immunity for reports made in good faith. The minimal standard of evaluation when abuse is suspected includes a properly done skeletal survey for the 0–24-month-old child, dilated fundoscopic examination by an ophthalmologist, and consultation by the child protective services team. The surgeon may be asked to testify as either a material witness or as an expert witness and so should be well prepared for either role.
KeywordsArthritis Ischemia Foam Osteoporosis Leukemia
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