Advanced Trauma Life Support ATLS Student Course Manual 2018

CHILD MALTREATMENT 207
Child Maltreatment
Any child who sustains an intentional injury as
the result of acts by caregivers is considered to be a
battered or maltreated child. Homicide is the leading
cause of intentional death in the first year of life.
Children who suffer from nonaccidental trauma
have significantly higher injury severity and a sixfold
higher mortality rate than children who sustain
accidental injuries. Therefore, a thorough history and
careful evaluation of children in whom maltreatment
is suspected is crucial to prevent eventual death,
especially in children who are younger than 2 years
of age. Clinicians should suspect child maltreatment in
these situations:
••
A discrepancy exists between the history and
the degree of physical injury—for example, a
young child loses consciousness or sustains
significant injuries after falling from a bed or
sofa, fractures an extremity during play with
siblings or other children, or sustains a lowerextremity
fracture even though he or she is too
young to walk.
••
A prolonged interval has passed between the time
of the injury and presentation for medical care.
••
The history includes repeated trauma, treated
in the same or different EDs.
••
The history of injury changes or is different
between parents or other caregivers.
••
There is a history of hospital or doctor “shopping.”
••
Parents respond inappropriately to or do not
comply with medical advice—for example,
leaving a child unattended in the emergency
facility.
••
The mechanism of injury is implausible based
on the child’s developmental stage (n TABLE 10-7).
The following findings, on careful physical examination,
suggest child maltreatment and warrant more
intensive investigation:
••
Multicolored bruises (i.e., bruises in different
stages of healing)
••
Evidence of frequent previous injuries, typified by
old scars or healed fractures on x-ray examination
••
Perioral injuries
••
Injuries to the genital or perianal area
table 10-7 baby milestones
AGE
TYPICAL SKILLS
1 month • Lifts head when supine
• Responds to sounds
• Stares at faces
2 months • Vocalizes
• Follows objects across field of vision
• Holds head up for short periods
3 months • Recognizes familiar faces
• Holds head steady
• Visually tracks moving objects
4 months • Smiles
• Laughs
• Can bear weight on legs
• Vocalizes when spoken to
5 months • Distinguishes between bold colors
• Plays with hands and feet
6 months • Turns toward sounds or voices
• Imitates sounds
• Rolls over in both directions
7 months • Sits without support
• Drags objects toward self
8 months • Says “mama” or “dada” to parents
• Passes objects from hand to hand
9 months • Stands while holding on to things
10 months • Picks things up with “pincer” grasp
• Crawls well with belly off the ground
11 months • Plays games like “patty cake” and “peek-a-boo”
• Stands without support for a few seconds
12 months • Imitates the actions of others
• Indicates wants with gestures
••
Fractures of long bones in children younger
than 3 years of age
••
Ruptured internal viscera without antecedent
major blunt trauma
••
Multiple subdural hematomas, especially
without a fresh skull fracture
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