STUDY OF CHILD ABUSE THROUGH FORENSIC ANALYSIS OF CONTUSIONS IN TODDLERS AS AN INDICATIVE FACTOR TO THE PRESENCE OF ABUSE

Background: Skin injuries are the most common and the most easily recognizable signs of abuse in children. Up to 90% of victims of physical abuse present skin injuries, the physician must rely on the other characteristics of the injuries and on other elements to identify physical abuse as delay in consulting, injuries incompatible with the history or the developmental stage and association with specific injuries in other systems. Although severe physical abuse has a greater chance of being identified, minor physical abuse is more difficult to distinguish from accidental injury. The most difficult situation is when the physician observes recent skin injuries in a child who is not consulting for trauma. Aim: The objective of our study was to collect data on the totality of recent skin bruises in normal toddlers and to investigate what patterns of bruising are diagnostic or suggestive of child abuse. Methods: Children younger than 36 months attending the outpatient clinic and the emergency room in Pediatricsʹ department, the children were examined for age, sex and the existence of other injuries, the reported cause of the contusion was identified and whether or not there was a suspected charge of abuse. Results: multiple bruises were found in 135 (65%) while the rest 65 (35%) presented with a single contusion. Contusion with associated injuries was presented in 74 (37%) of cases, where 45(22.5%) numbers presented with associated fractures, 9(4.5%) with internal bleeding, 20(10%) with other wounds. Out of the 200 cases 28(14%) were suspected to be child abuse. The majority of subjects75 %( 21) in this child abuse group did not show fractures, whereas only 25% (7) showed more than one fracture. Contusions were accompanied with internal hemorrhage in 2 of the cases and other types of wound in 4 of the cases. Conclusion: Contusions in toddlers appear to be a good indicative factor to the presence of other underlying injuries.