Kindesmisshandlung

Ätiologie
ca. 1 von 58 Kindern (in den USA) wird an einer Ambulanz vorstellig wegen körperlicher Misshandlung, andere Daten sprechen von 1 in 10 Kindern das körperlich misshandelt wird. Es gibt eine hohe Dunkelziffer! Genaue Anamneseerhebung bei jedem Patienten!

Diagnose
Auffällig sind folgende Zeichen (Liste aus: http://emedicine.medscape.com/article/915664-overview)

Anamese:
additional trauma is identified or as the cause of the trauma is questioned
 * Details change, or additional scenarios are suggested, as
 * Details are inconsistent among caregivers
 * Caregivers give implausible details not congruent with the trauma observed on examination
 * Caregivers describe minor trauma, but the child displays major injury on examination
 * No history of trauma is offered
 * Injury described as self-inflicted is not possible given the age/developmental abilities of the child
 * Caregivers demonstrate a significant delay in seeking treatment for the child
 * Serious injury is blamed on a younger sibling/playmate
 * Caregiver frequently changes healthcare facilities, pediatricians, or emergency departments

Klinische Zeichen:
forced immersion burn pattern; and classic abusive head trauma findings of subdural hematoma, retina hemorrhage, and skeletal injuries
 * Injury pattern inconsistent with the history provided
 * Multiple injuries/multiple types of injuries
 * Injuries at various stages of healing
 * Poor hygiene
 * Presence of pathognomonic injuries including loop marks;


 * Involvement of multiple areas of the body beyond bony prominences
 * Bruising of ears, facial cheeks, buttocks, palms, soles, neck, genitals
 * Bruises at many stages of healing
 * Bruises in nonambulatory child
 * Patterned markings resembling objects, grab marks, slap marks, human bites, and loop marks
 * Oral injury, lingular or labial frenula tears


 * ANY fracture in a nonambulatory infant without clear accidental and consistent mechanism
 * Metaphyseal fractures
 * Multiple, bilateral, differently aged posterior rib fractures
 * Multiple and complex skull fractures if only simple impact history
 * Spinous process fractures
 * Scapular fractures

fork, clothing iron, curling iron, cigarette lighter)
 * Patterned contact burns in clear shape of hot object (eg,
 * Classic forced immersion burn pattern with sharp stocking-and-glove demarcation and sparing of flexed protected areas
 * Splash/spill burn patterns not consistent with history or developmental level
 * Cigarette burns
 * Bilateral or mirror image burns
 * Localized burns to genitals, buttocks, and perineum (especially at toilet training stage)
 * Evidence for excessive delay in seeking treatment, and the presence of other forms of injury

Therapie
Zunächst medizinische Versorgung der entsprechenden Verletzung, dann Vorstellung bei Verdacht in der Kinderambulanz (3414) und in der Kinderschutzgruppe (Kontaktaufnahme mit Dr. Kabicek oder Dr. Pöltl) bzw. Kopie der Krankengeschichte ihnen ins Fach legen; Verständigung eines Facharztes.

Fotodokumentation!

Literatur
http://emedicine.medscape.com/article/915664-overview