Family Matters

How Small Bruises Lead to Big Ones in Child-Abuse Cases

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In more than two decades as a child-abuse pediatrician, Dr. Lynn Sheets has noticed a trend.

Often, when a seriously abused child arrives, perhaps with broken bones or head trauma, she looks back at medical records and finds that the same child often sustained minor bruises as an infant.

“That piqued my interest,” says Sheets, an associate professor of pediatrics at the Medical College of Wisconsin. Colleagues around the country noticed the same thing. “There are many cases where a child would have, say, a bruise on his cheek and the mother would say, It’s from bumping into a pacifier. Then several weeks later, that child would come in having been beaten or slammed or even killed.”

Those observations led Sheets to investigate the association between bruises in babies considered too young to be hurting themselves and later abuse. The results of her study, published this week in the journal Pediatrics, found that fairly minor injuries like bruises can forecast more severe abuse, a phenomenon known as sentinel injuries.

Sentinel injuries are unexpected injuries that occur in babies who can’t yet cruise — before they can pull to a stand and take a few steps while holding on to something. “Babies who are not yet cruising shouldn’t be bruising,” says Sheets, who is medical director at the Child Protection Center, Children’s Hospital of Wisconsin. “We already knew that, but what we didn’t know is that babies who’ve been horribly abused often have a previous history of bruising.”

(MORE: Child Abuse: Why It’s So Hard to Determine Who’s at Risk)

Sheets and her colleagues looked at three groups of babies under 1 year of age: infants who were abused, those who were evaluated but were found not to have been abused and babies where it was impossible to know whether injuries had resulted from abuse.

Of 401 babies studied, 200 were substantiated as abused, with 27.5% of them having previous documentation of minor bruises. Those babies whose injuries were not associated with abuse had zero prior reports of sentinel injuries; 8% of babies in the undetermined group had a history of minor injuries.

While the connection seems unsurprising, it’s important for helping doctors to navigate the challenging thickets of determining when abuse is occurring among the youngest victims. “If we can call them what they are — ‘sentinel’ injuries, or warning injuries — it helps people think differently about them,” says Sheets.

Providers should also be alert to implausible explanations that could hide the first signs of abuse, such as bumping and bruising in a precruising baby that’s explained as the infant banging her leg on the crib.

Babies, says Sheets, are actually pretty hard to bruise. They roll over into crib slats and swings all the time, and such bumping with their own body weight typically shouldn’t leave a mark. “It’s about heightening awareness,” she says.

(MORE: Study: Serious Child-Abuse Injuries Rise Slightly in the U.S.)

From a public-health perspective, it’s also about saving money: each case of child abuse carries with it an estimated $210,000 lifetime price tag, and identifying cases early or monitoring cases of suspected abuse could help to alleviate some of these costs.

To cut down on abuse, it’s helpful to understand that crying is the primary trigger that sets some parents off. Online campaigns such as the Period of Purple Crying teach parents that crying — lots of it, especially early on — is a normal developmental stage. “If we can identify abuse early,” says Sheets, “that in and of itself may help families get additional resources to deal with the stress of a new baby.”

15 comments
WandaWalls
WandaWalls like.author.displayName 1 Like

Really, do you think, my God this is something we have been trying to preach for years, now suddenly the "experts" have seen the pattern, well Cuddos to them!

WarAgainstABUSE
WarAgainstABUSE

Say NO to Child Abuse. More than 200 cities on Board!! 

MACA is a non-partisan, grass roots, nationwide effort, to UNITE ALL Child Advocates together in solidarity on April 22, 2013 for peaceful demonstrations against child abuse and crimes against children in the U.S.

April is National Child Abuse Prevention Month. We seek to raise awareness of and ask for tougher sentencing for violent crimes against children in the U.S.

Statistics on crimes against children each year in the U.S. are staggering, sobering and should compel EVERY adult, parent, father, uncle, son, grandfather and all mothers, aunts, daughters, grandmothers and women to be moved to do something NOW. At a recent Washington Congressional hearing in June, 2011, experts believe nearly 10 children die each day from abuse. NCANDS, the national database for crimes against children, didn't receive data from 3 states in their latest report! States are NOT mandated to report child fatalities as a result of CAN or any type of abuse whether fatal or not! We are NOT seeking to create more bureaucracy, but rather, demanding our lawmakers begin to protect our children through stiffer sentencing for child abuse, including mandatory life without parole for violent crimes such as child rape and murder.
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WarAgainstABUSE
WarAgainstABUSE

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KidLawRich
KidLawRich

.%s How Small Bruises -> Big Ones ... %sX%sa%shts see my comments as kidlaw.ri%sIME

kidlaw.rich
kidlaw.rich

It is not clear to me from the article how Sheets and her colleagues determined that they had a group of babies "who were abused". Was it a CPS or court decision that just relies on a doctor's decision and so is circular at best? Was it an M.D. on a Child Protection service who could have been persuaded by confirmation bias to find evidence to confirm the suspected abuse that caused the ER to refer the child to the CP team in the first place? Were these infants tested for genetic, metabolic, endocrine or microbial conditions that could lead to easy bruising or even just conditions that mimic bruising?

If an infant is identified as having been abused without adequate testing, labeling the infant as abused when it was not does nothing to correct the underlying condition and protect the child from further ill effects of the unidentified condition.

622w
622w

@kidlaw.rich The entire study is published in the April edition of Pediatrics. It was thoroughly reviewed by a number of experts. Read the article if you want the details rather than relying on a short summary in Time magazine online.

622w
622w

@kidlaw.rich The study is printed in its entirety in the April edition of the publication "Pediatrics". The details are there, not in the short summary in Time online. Before jumping to your wild conclusions why don't you read the entire study. Most cases that are determined to be actual abuse involve confessions of the perpetrators. For these studies to reach this point they have been reviewed by numerous experts. Do you have some axe to grind with the system?

LaddieSchnaiber
LaddieSchnaiber like.author.displayName 1 Like

@TIME @TIMEHealthla Once you a bruise on a child become suspicious. when you see several bruises on a child, call the authorities.