Case 46

A 10-year-old boy was admitted to the paediatric intensive care unit after being hit by a car. He was riding his bike alone at 11 p.m. in the street. He had a closed head injury, but was conscious and able to answer questions. A full physical examination revealed several marks on his right thigh and left back as shown in Images 46a and 46b. When asked, he disclosed he was whipped with a cord by his mother’s boyfriend. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig46a.jpg"/> https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig46b.jpg"/>

How would you further evaluate this patient?

106There was concern for inadequate supervision and neglect of this child. This prompted the involvement of the hospital’s child protection team which was able to obtain a thorough history and physical examination and to properly document the injuries. It is important for all patients to have a detailed physical examination especially when there are concerns of child maltreatment. ¹ This child’s physical examination revealed multiple loop marks that were consistent with his disclosure of being whipped with a cord. Patterned bruises and injuries in children should raise the suspicion of child abuse especially when they resemble certain objects that are used to inflict injuries (e.g. cords) as in this child. Inflicted injury also tends to occur in places away from bony prominences such as the buttocks, trunk, hands, upper arm, head and neck. ² Child Protective Services were notified due to the physical abuse as well as the neglect. This child did not need any further laboratory testing or imaging specific for the abuse in addition to what he received due to the trauma related to being struck by the car. His evaluation did not reveal any further injuries.