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Some common physical signs to be aware of in practice include but are not limited to, several injuries at different stages of healing, any injury that can not be explained or was not witnessed, anyinjury or bruise that does not match up with parent explained mechanism, any genital bruising or STD in children. Behavioral signs can sometimes be red flags for abuse as well. These signs include but are not limited to fearful of behavior of an adult or caregiver, bed wetting, running away, depression or withdrawal, extreme affectionate behavior, extreme sexual behavior, nightmares, headaches or stomach with no medical cause as well as failure to gain weight or sudden change in confidence level (Krause, 2016).In Tommy’s case, the parent story that Tommy fell out of the bed from a nap did not match up with the 10cm abdominal bruise and abdominal pain that Tommy presented with. Additionally, old rib fractures and ligature marks were also noted which suggests that there were several incidences of abuse that occurred over time. Additionally, upon skeletal survey, which is the first line when assessing for child abuse, he had several rib fractures that healed. Diagnostic imaging is a crucial and necessary component in assessing for child mistreatment and abuse in children (Jain, 2015). Bruising is one of the most obvious signs of physical child abuse ( Djordjevic, Slavkovic, Marjanovic, & Zivanovic, 2015 ) In Tommy’s case, he had a 10 cm long bruise on his abdomen as well as bruising on his lower extremities that seemed to be from previous abuse. Because children do not have the strength in the abdominal wall muscles to protect the inner structures and organs of the thoracic area, blunt force trauma is one of the more common injuries s seen in child abuse cases. It is also the easiest to miss because the organs are inside and behind each other in the abdominal cavity. In Tommy’s case, he had a duodenal hematoma, which is highly suggestive of child abuse via blunt trauma. Careful assessment of the abdominal is crucial in identifying blunt force trauma. Signs to watch for in the primary and emergency settings include but ae not limited to, signs of circulatory compromise, bruising, marks or wounds on the abdomen, abdominal tenderness, abdominal distention, guarding, or abdominal tenderness as well as any blood in the urethral meatus. In tommy’s case, he had distention as well as guarding ( Djordjevic, Slavkovic, Marjanovic, and Zivanovic, 2015).
Child abuse is the third leading cause of death among children ages 1-4 (Kodner, & Wetherton, 2013,). All health care providers as well as ancillary staff are mandated reporters. A multi-disciplinary team approach is most beneficial in improving patient outcomes. After the ABS’sand initial resuscitation and stabilization of Tommy, notification of child welfare as well as the police and hospital security is necessary to ensure Tommy’s safety as well as the other two children in the home who were subsequently removed. The mother’s boyfriend was arrested, and Tommy’s mom had supervised visitation with the children. Luckily, the abuse was identified and treated