Professional Documents
Culture Documents
Wendy Chen MSW , Ruth Balaban MA RN , Varda Stanger PhD , Ra'aya Haruvi MSW , Shmuel Zur MD
Department of Pediatric Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel
Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
Key words:
under age 18) were arriving at hospital emergency rooms not only
abuse and neglect [25]. The importance of this body and its role
received greater impetus in 1989 when the reporting of suspected
Types of abuse
Physical abuse
that the hospital setting has much to offer to this field. Numerous
ment, and ultimately change. The hospital site is often the primary
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Skeletal injury
Skin injury
the child, and commonly occur when crawlers and toddlers yank
containers, and cups and pots filled with hot liquids. The spill
pattern in such cases is typical, with the largest and severest burn
areas or areas that are usually protected, e.g., the back, genitals,
occurring at the initial point of contact with the body, usually on the
anterior chest, and less severe burn in narrower areas as the liquid
travels down the body. There are also associated splatter marks.
Contact burns can also occur accidentally, usually on the palms but
underlying injury. The color of the bruise is indicative of its age and
also on other body parts as children pull down or fall onto hot
the skin with objects. Attempts by the child to move away from the
ential bruises around the wrists and ankles from binding [11,12].
Accidental burns are usually the result of hot liquids that spilt on
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into the dermis [11]. One must bear in mind that even accidental
Sexual abuse
with
the
perpetrator
child
being
or
another
used
for
person.
sexual
Sexual
stimulation
abuse
may
of
the
also
be
Abusive head trauma is the most common cause of death from child
and trauma. In 1962, Kempe et al. [20] included head injury in the
from a bed or down a short flight of stairs, does not produce enough
turbances,
enuresis,
encopresis
or phobias.
The
pediatrician
al. [25] as follows: a) direct impact injuries, which occur when high
Abdominal injury
also suggestive of sexual abuse [31,32]. Before referring the case for
certain that the child did not acquire the sexually transmitted
threatening event for both the child and his or her family, and it
for the suspicion. Only after the information given by the caretaker
further examinations.
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Neglect
Physical Neglect
basic needs of a child by those who are responsible for him or her
correctly or on time.
Neglect may also be the result of the parent's lack of skills and
This kind of neglect calls for involvement of both the police and
makes the child ill. The results of this falsification include multiple
hospitalizations and unnecessary harmful and often intrusive
process.
victim and his or her siblings. Victims are passive toward the
Assessment
The purpose of the hospital assessment of child abuse or neglect is
Figure 4. Physical neglect manifested by gluteal wasting, severe diaper rash
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mark the first stage of the assessment process and the subsequent
Medical Center in 1986. Since 1991, the Sheba Medical Center has
maltreatment.
solely on the basis of the physical symptoms. There are very few
two spheres the ``here and now,'' and the background functioning
of the child and family. The ``here and now'' refers to the assessment
the nurses for the clinical observation. However, in order for the
the parents.
conclude that a child was abused when, in fact, he or she was not
the child and family members are not in their natural environment
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ating with child protection officers of local welfare services, with the
Acknowledgement.
director of the National Social Work Service of the Ministry of Health, for
her assistance.
The photographs were reproduced from the study kit ``Child Maltreat-
Differential diagnosis
Medical personnel who evaluate children for child abuse and
neglect must be familiar with the many pediatric conditions that
may mimic the physical manifestations of child abuse. These
include genetic, metabolic and other disorders such as: osteogenesis imperfecta (especially type IVb), glutaric aciduria, Ehlers-
References
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Correspondence:
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Destroying tumors by special delivery
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ligand for integrin, and death of the target endothelial cells was
al. now show that cationic nanoparticles (NPs) can deliver a toxic
mice.
Science 2002;296:2404
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DNA damage and aging
A popular theory postulates that aging is triggered by cellular
strophy (TTD). The XPD mutant mice, which are severely impaired
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Science 2002;296:1276
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