• Infants, Toddlers and Preschoolers are at highest risk
o Demanding, Defenseless-can't get away/easy target, Can't talk-non-verbal, can't seek help.
o Kids with added needs- difficult temperament, illness, issues with prematurity, developmentally delayed, colick, extra burden
o Highly active kids, kids with difficult temperament, children with ADHD. Doesn't matter what temperament the kid comes out- it's the match between parent and child. Child may remind parent of someone that they don't like. Resented child- unwanted pregnancy, difficult labor/delivery. Child is unintentionally contributing to the problem. "They asked for it" in parents mind. Try and help situation- offer breaks for mom.
• The most common finding in physical abuse.
• Look at bruises. Bruises are not able to be timed. No way to time it- can see if they're all at the same stage. But depends on if bony prominence underneath, what tissue is affected. Look for suspicious bruises- cheeks, ear lobes, upper lip, frenulum (force feeding) , buttocks, lower back, thighs, genitals, neck.
• Multiple bruises on a kid under 1 should be suspect for abuse! Need a really good explanation. If you don't cruise, you shouldn't bruise.
• Shouldn't see bone fractures either. 82% of long bone fractures in kids under 1 proved to be abuse.
• ½ of skull fractures in infants are result of abuse
• Look at normal infants under 6 months old- normal bruises would be on head
• Look at location and pattern of bruises!!!
• Kids normally injure specific areas doing normal kid things
o Elbows, knees, shins, head.
• NOT normal- Punch in the face, scalpulae, middle of back, buttocks, groin, thighs.