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Oral injuries and occult harm in children evaluated for abuse
Molly V Dorfman1, James B Metz2, Kenneth W Feldman2
1Pediatric Critical Care Medicine, Valley Children's Hospital, Madera, California, USA.
Insights
Children with oral injuries are at high risk for occult abusive injuries, especially infants and mobile preschoolers. Unexplained oral injuries in young children warrant thorough evaluation for physical abuse.
Area of Science:
- Pediatrics
- Forensic Medicine
- Child Abuse Research
Background:
- Oral injuries are common in child abuse evaluations.
- Identifying occult trauma is crucial for accurate diagnosis and intervention.
Purpose of the Study:
- To determine the frequency of occult trauma in children presenting with oral injuries during physical abuse evaluations.
- To assess the risk of additional abusive injuries in this population.
Main Methods:
- Secondary analysis of a prospective, observational study involving 20 US child abuse teams (Examining Siblings to Recognize Abuse network).
- Included children under 120 months old evaluated for physical abuse, focusing on those with oral injuries.
- Analyzed rates of oral injury, occult injury testing (skeletal surveys, neuroimaging, retinal exams), and perceived abuse likelihood.
Main Results:
- 3.3% of 2890 child abuse consultations involved oral injury (n=96).
- Occult fractures were found in 25% of skeletal surveys, 38% of neuroimaging revealed injuries, and 24% of retinal exams showed hemorrhages.
- Children with oral injuries had a higher likelihood of abuse concern (67% vs. 33%) and more occult injuries compared to other subjects.
Conclusions:
- Children with oral injuries face a significant risk of associated occult abusive injuries.
- Infants and mobile preschoolers are particularly vulnerable populations.
- Unexplained oral injuries in young children necessitate comprehensive abuse evaluations.
Objective:
To determine the frequency of occult trauma in children with oral injury evaluated for physical abuse.
Design:
This was a retrospectively planned secondary analysis of a prospective, observational study.
Setting:
Emergency departments supported by 20 US child abuse teams in the Examining Siblings to Recognize Abuse (ExSTRA) network.
Patients:
Children <120 months old evaluated for physical abuse.
Interventions:
Analysis of index children with oral injury on initial examination.
Main Outcome Measures:
Rates of physician-recognised oral injury, as well as frequency and results of occult injury testing. Perceived abuse likelihood was described on a 7-point scale (7=definite abuse).
Results:
Among 2890 child abuse consultations, 3.3% (n=96) of children had oral injury. Forty-two per cent were 0-12 months old, 39% 1-3 years old and 18% >3 years old. Oral injury was the primary reason for evaluation for 32 (33%). Forty-three per cent (42/96) had frenum injuries. Skeletal surveys were obtained for 84% and 25% of these identified occult fractures. Seventy-five per cent had neuroimaging; 38% identified injuries. Forty-one per cent of children with oral injuries had retinal examinations; 24% of exams showed retinal haemorrhages. More occult injuries were found in children with oral injuries than other ExSTRA subjects. A high level of concern for abusive injury was present in 67% of children with oral injury versus 33% without.
Conclusions:
Children with oral injury are at high risk for additional occult abusive injuries. Infants and mobile preschoolers are at risk. Young children with unexplained oral injury should be evaluated for abuse.
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