Emergency diagnosis and management of physical abuse and neglect of children

Injuries due to child abuse have continued to attract the attention of investigators. There was new evidence to show that cardiopulmonary resuscitation is a rare cause of rib fracture and that posterior rib fractures without a history of significant trauma are highly suggestive of abuse. An autopsy study examined ocular nerve sheath hemorrhage in deaths caused by abuse. The incidence and characteristics of abuse and neglect were studied for drowning victims. Female circumcision was well described, and physicians need to familiarize themselves with this cultural practice. The American Academy of Pediatrics published policy statements on sudden infant death and shaken baby syndrome. They stressed the need for protocols to deal with unexpected childhood deaths and to obtain autopsies in such cases. Reviews of fractures of abuse and retinal hemorrhages were enlightening. Reporting abuse and coping with violence remained topics of interest.