"High-risk parent-child interaction"
- Unrealistic expectations
- Isolated parent; esp. teenage parents living alone
Shaking--rarely causes injury in >1yo; causes long-bone
metaphyseal fx, esp. bilat horiz. metaphyseal fx;
- Rib Fx, from grabbing & squeezing; almost never
result from falling or other accidents
- Battle's sign; racoon eyes
- Multiple spiral fx.
- Wounds in various stages of healing.
- Accidental discovery of injury during complete exam
- Cognitive development should be assessed if neglect
- Dermatomyositis--looks like burns
- Osteogenesis imperfecta
- Leukemia--easy bruising due to thrombocytopenia
- Congen. syphilis
- Birth injury
Serum transaminase levels may be elevated in children with abdominal trauma