Child/Adolescent Health

Certain types of severe abdominal injury may signal child abuse in young children

Certain abdominal injuries may signal child abuse in children younger than 5 years, suggests a new study. Young children with severe injuries to the pancreas or hollow viscous organs (for example, small bowel or colon), or severe abdominal injuries in the context of either brain injury or malnourishment should be evaluated for possible abuse. Researchers identified 664 cases from the National Pediatric Trauma Registry of blunt abdominal injury (excluding motor vehicle injuries) in children up to 4 years of age. This database includes information from pediatric trauma centers on pediatric trauma, its causes, treatment, and consequences.

The three most common mechanisms of abdominal injury were suspected child abuse (40.5 percent), falls (36.6 percent), and being struck (not child abuse, 9.7 percent). Liver injury was the most common intra-abdominal injury (46.1 percent), followed by splenic (26 percent), hollow viscous (17.9 percent), and pancreatic (8.6 percent) injuries. Child abuse was suspected in 84 percent of deaths.

The medical diagnosis of suspected child abuse was significantly associated with all patient and injury characteristics evaluated: mortality, undernourishment, young age, traumatic brain injury, hollow viscous injury, pancreatic injury, and other intra-abdominal injuries. More than three-quarters of hollow viscous injury and two-thirds of pancreatic injury and traumatic brain injury were found in the suspected abuse group. In contrast to patients in the child abuse group, 15 percent of whom were undernourished, less than 5 percent of the nonabused group were undernourished. The study was supported in part by the Agency for Healthcare Research and Quality (HS00060).

See "Patient and injury characteristics in abusive abdominal injuries," by Matthew Trokel, M.D., M.A., Carla Discala, Ph.D., Norma C. Terrin, Ph.D., and Robert D. Sege, M.D., Ph.D., in the October 2006 Pediatric Emergency Care 22(10), pp. 700-704.

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