Anil Aggrawal's Internet Journal of Forensic Medicine, Vol 6, No. 2, (July - December 2005); Toxicology: Need of the hour (Editorial by Hugo D. Rodríguez Almada, Uruguay)
  home  > Vol.6, No. 2, July - December 2005  > Editorial by Hugo D. Rodríguez Almada (you are here)
Navigation ribbon

  : EMBASE Accession Number: 2005446709



Ref: Almada HDR. Non-accidental injuries in children (Editorial). Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology, 2005; Vol. 6, No. 2 (July - December 2005): ; Published July 1, 2005, (Accessed: 

Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology

Volume 6, Number 2, July - December 2005

Editorial

Non-accidental injuries in children: Common pitfalls and how to avoid them

-Hugo D. Rodríguez Almada
General Secretary of the Ibero-American Society of Medical Law,
Bulevar Artigas 1515 C.P. 11200
Montevideo-Uruguay

Email: hrodrigu@mednet.org.uy


Hugo D. Rodríguez Almada, Uruguay
Hugo D. Rodríguez Almada, Uruguay
Click picture to enlarge

Non-accidental injuries in children as old a problem as mankind itself. However, only in 1946, with the classical paper by Caffey did its systematic study begin. In 1962, Kempe, Silverman and co-authors used for the first time the expression battered-child syndrome .

Progressively, the physicians and the pediatricians acquired a better knowledge of the battered-child syndrome. This made it possible to increase the number of diagnosed cases and reach the diagnostic forms earlier.

Unfortunately, also the phenomenon of the misdiagnosis arose. The medical publication databases already have hundreds of communications of cases of erroneous diagnosis of child abuse.

Conditions that have been mistaken for child abuse are several and very varied. Numerous congenital or acquired, localized or systemic diseases still are cause of this mistaken diagnosis. Among them the following may be mentioned:

Editorial by Hugo D. Rodríguez Almada, Uruguay - Pullquotes
. . .Serious mistakes can also be made in the diagnosis of the sexual abuse in the young children. Sometimes the pediatricians and the medical examiners themselves make the mistake to apply to the children diagnostic criteria that are only valid for the adult people. . .

Serious mistakes can also be made in the diagnosis of the sexual abuse in the young children. Sometimes the pediatricians and the medical examiners themselves make the mistake to apply to the children diagnostic criteria that are only valid for the adult people.

In the young children the violation is extremely rare. This is due to anatomical reasons. The sexual abuse of children implies certain forms of stimulation by the attacker among which almost never is present the penetration. That's why habitually it does not leave any evidence physical objective.

It is frequent that the abused children present a very nonspecific symptomatic pattern, as various indicators of depression, aggressively, unexplained changes in the school performance. Unfortunately these elements tend not to be adequately assessed. On the contrary, in practice it is common to find denunciations unjustifiable by sexual abuse of children by findings in vulva or anus that do not bear a relation to the sexual abuse.

The following ones are only some of the most common causes of misdiagnosis of sexual abuse in the children:

Editorial by Hugo D. Rodríguez Almada, Uruguay - Pullquotes
. . .One currently insists that the intervention strategies in cases of possible abuse or sexual abuse should guarantee the protection of the child without undermining the rights of the parents with unjustifiable accusations. In few cases as this, the possibility of mistreatment or sexual abuse in children, our competition as medical examiners turns out testing. . .

Is known that when the physician is not capable of diagnosing the battered-child syndrome or the sexual abuse the child is exposed to a certain risk of new and major injuries, whose outcome can become the death.

It should also be aware that the misdiagnosis of child abuse is a serious iatrogenic consequences for the child, the suspected perpetrator and their family.

One currently insists that the intervention strategies in cases of possible abuse or sexual abuse should guarantee the protection of the child without undermining the rights of the parents with unjustifiable accusations. In few cases as this, the possibility of mistreatment or sexual abuse in children, our competition as medical examiners turns out testing. In the cases of bettered child syndrome and sexual abuse of children we should be capable of offering to the judicial system conviction elements that permit a timely intervention. At the same time, we should minimize the margin of error in its diagnosis.

Both the physicians of the health system and the medical examiners we should be capable of doing a certain diagnostic, using clinical and paraclinical methodology, capable of excluding other possible causes of explaining the findings suspected.

Further Reading

 (1) Academy of Pediatrics Committee on Child Abuse and Neglect. Guidelines for the evaluation of sexual abuse of children: subject review. American Pediatrics. 1999 Jan;103(1):186-91.

 (2) Caffey J. Multiple fractures in the long bones of infants suffering from chronic subdural hematoma. Am J Roentgenol Radium Ther 1946; 56: 163-73.

 (3) Carpentieri U, Gustavson LP, Haggard ME. Misdiagnosis of neglect in child with bleeding disorder and cystic fibrosis. South Med J 1978; 71:854.

 (4) Colver GB, Harris DWS, Tidman MJ. Skin diseases that may mimic child abuse. Br J Dis Dermatol 1990; 139:239. 

 (5) Christian CW, Lavelle JM, De Jong AR, Loiselle J, Brenner L, Joffe M. Forensic evidence findings in prepubertal victims of sexual assault.  Pediatrics 2000;106: 100-4.

 (6) Fiser RH, Kaplan J, Holder JC. Congenital syphilis mimicking the battered child syndrome: how does tell temp apart? Clin Pediatr 1972; 11:305.

 (7) Gahagan S, Rimza ME. Child abuse or osteogenesis imperfecta: how can we tell? Pediatrics 1991; 88:987.

 (8) Horodniceanu C, Grunebaum M, Volovitz B, Nitzan M. Unusual bone involvement in congenital syphilis mimicking the battered child syndrome. Pediatr Radiol 1978; 7(4):232.

 (9) Kaplan JM. Pseudoabuse-the misdiagnosis of child abuse. J Forensic Sci 1986; 31:1420.

 (10) Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK. The battered-child syndrome. JAMA 1962; 181:17-24.

 (11) Kirschner RH, Stein RJ. Mistaken diagnosis of child abuse. Am J Dis Child 1985; 139:873.

 (12) Loredo Abdala A. Maltrato al menor. México: Interamericana-McGraw-Hill, 1994.

 (13) Ludwig S, Kornberg AE. Child abuse: a medical reference. 2ª ed. New York , Churchill Livingstone, 1992.

 (14) Mc Clain JL, Clark MA, Sandusky GE. Undiagnosed, untreated acute lymphoblastic leukemia presenting as suspected child abuse. J Forensic Sci 1990; 35:735.

 (15) Oates RK. Overturning the diagnosis of child abuse. Arch Dis Child 1984; 59:860.

 (16) O'Hare AE, Eden OB. Bleending disorders and non-accidental injury. Arch Dis Child 1984; 59:860.

 (17) Paterson CR, Mc Allion S, Miller R. Osteogenesis imperfecta with dominant inheritance and normal scleare. J Bone Joint Surg [Br] 1983; 65:35.

 (18) Paterson CR, McAllion SJ. Child abuse and osteogenesis imperfecta. Br Med J 1987; 295:1561.

 (19) Reece RM. Child abuse: medical diagnosis and mangement. Boston, Lea & Febiger, 1994.

 (20) Rodríguez H, Pais T. Diagnóstico erróneo de síndrome de niño maltratado. Rev Med Uruguay 1996;  12: 44 -48.   

 (21) Rodríguez H Abuso sexual en niños: enfoque medicolegal. In. Baráibar R: La salud en la infancia y la adolescencia. Montevideo, Arenas, 1999: 14149.

 (22) Schweich W, Brueschke EE, Dent T. Family practice grand rounds: hemophilia. J Fam Pract 1982; 14:661.

 (23) Stevenson O. La atención al niño maltratado. Barcelona, Paidós, 1992.

 (24) Whaerler DM, Hobbs CJ. Mistakes in diagnosing non-accidental injury: 10 year's experience. Br Med J 1988; 296: 1233.

 (25) Winship IM, Winship WS. Epidermolysis bullosa misdiagnosed as child abuse. South Afr Med J 1988; 73:369.

 (26) Wright JT, Thornton JB. Osteogenesis imperfecta with dentinogenesis imperfecta: a mistaken case of child abuse. Pediatr Dent 1983; 5:207.

 


 N.B. It is essential to read this journal - and especially this editorial as it contains several tables and high resolution graphics - under a screen resolution of 1600 x 1200 dpi or more. If the resolution is less than this, you may see broken or overlapping tables/graphics, graphics overlying text or other anomalies. It is strongly advised to switch over to this resolution to read this journal - and especially this editorial. These pages are viewed best in Netscape Navigator 4.7 and above.

-Anil Aggrawal


 Editorials - Cumulative Index

 Request a PDF file of this editorial by clicking here. (If your screen resolution can not be increased, or if printing this page is giving you problems like overlapping of graphics and/or tables etc, you can take a proper printout from a pdf file. You will need an Acrobat Reader though.)

 



 Click here to contact us.

 This page has been constructed and maintained by Dr. Anil Aggrawal, Professor of Forensic Medicine, at the Maulana Azad Medical College, New Delhi-110002. You may want to give me the feedback to make this pages better. Please be kind enough to write your comments in the guestbook maintained above. These comments would help me make these pages better.

IMPORTANT NOTE: ALL PAPERS APPEARING IN THIS ONLINE JOURNAL ARE COPYRIGHTED BY "ANIL AGGRAWAL'S INTERNET JOURNAL OF FORENSIC MEDICINE AND TOXICOLOGY" AND MAY NOT BE REPOSTED, REPRINTED OR OTHERWISE USED IN ANY MANNER WITHOUT THE WRITTEN PERMISSION OF THE WEBMASTER

Questions or suggestions ? Please use  ICQ 19727771 or email to dr_anil@hotmail.com

Page Professor Anil Aggrawal via ICQ

  home  > Vol.6, No. 2, July - December 2005  > Editorial by Hugo D. Rodríguez Almada (you are here)
Navigation ribbon