Battered Baby Syndrome Research Articles

Beaten to Blindness: Battered Baby Syndrome

Introduction: A battered child is one who sustains repetitive physical injuries due to non-accidental violence inflicted by a parent or guardian. Child abuse encompasses behaviors exposing the child to various forms of physical or sexual abuse, neglect, or emotional misconduct. Typically, battered child syndrome is diagnosed through a disparity between the history provided by the child's caregivers and the findings of clinical examination. Case details: An 18-month-old girl child was admitted to a tertiary care hospital, presenting with a four-day history of fever, vomiting for two days and a seizure episode. The child had a history of head injury one week ago, resulting in transient unconsciousness. Upon examination, multiple healed and fresh injuries were observed on the face, hands, and right thigh. CT brain revealed hypodensity areas with a mildly displaced fracture of the left frontal bone. Fundus examination identified bilateral multiple intraretinal hemorrhages and papilledema. X-ray showed a fracture of the right proximal tibia. The child required ventilator support during the hospital stay, and subsequently, developed retinal blindness. The child was managed accordingly. Discussion: The classical feature of Battered Baby Syndrome is the discrepancy between the nature of injuries and the history provided, and the delay between the injury and medical attention. The parental risk factors for child abuse are poverty, social isolation, drug addiction, violent environment, family history of abuse, communication skills deficit and the child related risk factors are children with special needs, children with behavior problems, bonding deficit. etc. Conclusion: The current case sheds light on the unfortunate prevalence of this condition within the Indian context, urging point-of-care health providers to stay vigilant and informed about child abuse patterns in the community. It serves as a crucial reminder of the responsibility we all share in safeguarding the well-being of children.

Battered baby syndrome

Battered child syndrome, shaken baby syndrome, non accidental injuries of childhood, etc. are all variants of forms of child abuse that has many names but a single outcome – the child is injured at the hands of perpetrators. A four- months old female child was brought to the hospital with multiple bruises, left upper and right lower limb swelling with an open wound over right leg. On detailed examination and investigations, multiple fractures found in radius, ulna & amp; humorous in left hand and fracture of femur with tibia epiphyseal separation in right leg. The etiology was unclear at presentation. History obtained from the mother and father, was of conflicting nature. Inter-caste love marriage of mother and father, poor family support, poverty, presence of multiple bruises over the body, blue black discoloration of skin over right leg with multiple fractures revealed in X - Ray scan lead to the diagnosis of bettered baby syndrome.

Purtscher-like retinopathy-unusual initial presentation of rheumatoid arthritis.

Purtscher-like retinopathy is a rare phenomenon reported in disorders including acute pancreatitis, collagen vascular diseases, fat embolism, chronic renal failure, amniotic fluid embolism, battered baby syndrome and several autoimmune diseases. We report an atypical initial feature of rheumatoid arthritis in a middle-aged male. This case will raise awareness among generalists to recognize this disease early.

Scapular Caffey’s disease: A masquerading swelling in an infant, a case report and review of literature

Caffey’s disease was characterized by a triad of symptoms, irritability, soft tissue swelling, and underlying cortical bone thickening. It mostly occurs before the first 5 months of life in infancy. The knowledge of this pathology was essential as it masquerades as wide range diseases including acute osteomyelitis, bone tumors, trauma, battered baby syndrome (child abuse), hypervitaminosis a, scurvy, infantile malignant osteopetrosis, neonatal tuberculosis, congenital syphilis, pseudoparalyis of infancy which was more common and require specific management including extensive surgery. Classically, infantile cortical hyperostosis disease occurs in the early part of the first year of life. Infantile cortical hyperostosis was characterized by a clinical triad (fever, soft-tissue swelling, hyperirritability) and a clinching radiographic picture of underlying cortical hyperostosis (thickening or bony expansion). We reported a case of scapular swelling in a 2 -month-old infant where a retrospective diagnosis of caffey’s disease was made. We proposed a high clinical suspicion for early diagnosis of Caffey’s disease and hence appropriate management.

Chronic Subdural Hygroma in Battered Baby.

The battered baby syndrome is a condition in which a child is seriously physically abused by thecaregiver or parents. The World Health Organization (WHO) estimates 40 million children aresubjected to abuse and neglect around the world. Most of the industrialized countries have theirreporting and surveillance system and data on child battery but in developing countries includingIndia, there is a lack of data regarding the extent of child battering that takes place within thehouseholds or institutions. India published a report on one of the largest surveys done on childabuse and found that two out of every three children were physically abused and 88.6% of themsuffered at the hands of their parents. Unfortunately, the methodology restricted the study to onlyolder children who could give a history of abuse. Therefore, the magnitude of the problem given onlyhighlights among children above the age of 5 years. [1]. we are reporting a case of an Infant withFebrile encephalopathy, detailed examination and investigation found out a case of chronic SubduralHygroma with classical neuroimaging features of Abusive trauma. We have done a multidisciplinaryapproach with a Neurosurgeon, a social worker who treated the child with burr hole surgery forsubdural hygroma & the child recovered with consciousness. This case is Special because a 5-monthMale infant was subjected to abuse due to a psychological problem in a Family Member, suspicionwas lacking as males are unlikely to undergo gender-biased in India and Early age of presentation.

Imaging the pediatric retina: An overview.

Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.

Postmortem Detection of Child abuse at a Premier Hospital: Two Case Reports

Physical Child abuse also known as Battered baby Syndrome (BBS) or Non Accidental Injury (NAI) occurs when the child suffers repetitive physical injuries by a parent or guardian. It can cause severe injuries to the children and even death. We report two autopsy cases in which both the children were brought dead in the All India Institute of Medical Sciences (AIIMS), New Delhi by the guardians with no complaint of foul play. During autopsy the characteristic findings of physical abuse were found and were reported to the investigation officer. It led to the arrest of the guardians and legal proceedings were initiated. The western countries have developed a centralized reporting system for child abuse but the cases of physical and mental abuse of children mainly at their home from parents or guardian are highly under-reported in India. The authors intend to highlight the importance of interpreting such injuries not only during autopsy but also in clinical setups so that perpetrators of child abuse are not spared. The authors have given recommendations about the steps which could be taken to detect child abuse at an early stage and save the life of a child.

Battered baby syndrome

The problem of battered baby and child abuse is a much underreported condition, easily missed by the attending physician and autopsy surgeon. According to a study by the Ministry of Women and Child Development, India, in 2007, more than two-thirds (69%) of children, particularly in the age group of 5–12 years, faced physical abuse, mostly (89%) by parents. Sexual abuse occurred in over half of them (53%) and every second child faced emotional abuse, mostly by parents (83%). In this presentation, we will be sharing the experience of managing two cases of battered baby syndrome, reported at a tertiary health care centre in India.

Battered Baby: A Case Report

Introduction: We report on a three-year-old child, a case of battered baby syndrome. Case Presentation: A three-year-old female child was brought with multiple bruises, fracture of left femur and features of raised intracranial tension. The etiology was unclear at presentation. Inconsistencies in history given by the mother, a background of poverty and single parenthood, presence of multiple bruises over the body, multiple infarcts in Computerized Tomography (CT) scan, absence of external calvarial injuries and finally subdural hematoma in the autopsy report led to the diagnosis of child abuse. Conclusions: Every clinician must be alert to the possibility of battered baby in a child with multiple injuries.

Battered Baby Syndrome: A Barbaric Act

Battered baby syndrome is a heinous crime and brutish act. Knowledge of such cases gives us the thought that we are still living in barbaric era. By the thought of such cases one gets goose bumps. The battered child refers to the child usually less than three years of age, though it may occur at any age, who suffers repeated non-accidental injuries, sometime fatal, caused through episodes of violence by a parent or guardian. Physicians have a duty and responsibility to the child to require a full evaluation of the problem and to guarantee that no expected repetition of trauma will be permitted to occur. Forensic expert also has an important role to play in uncovering the cases of battered baby syndrome. We present two incidences of battered baby syndrome aged 12 year and 5 year. The first was a male child who committed suicide by hanging after beaten repeatedly by her mother. The second case was a female child, admitted in our hospital pediatrics side beaten repeatedly by her father.

Long-term outcomes of the shaken baby syndrome prevention program: Turkey's experience.

Shaken baby syndrome (SBS) is a condition which may cause to serious health problems in the baby. SBS may be prevented by increasing awareness with giving education to parents especially in the early postnatal period. In shaken baby prevention programs, education is recommended to be given before the 2-4(th) month during which the frequency of crying is increased. It is important that education given in the early period is permanent until the period during which the frequency of crying is increased. The aim of this study was to evaluate the persistency of the benefit of the SBS prevention program until the 2-4(th) month during which crying is intensified. This study is an interventional study. When the babies became 2-4 months old, a questionnaire which questioned the usefulness of education and the experiences with babies was applied to a group selected randomly among the mothers who received SBS prevention education during pregnancy or in the first 7 postnatal days (group A). The same questionnaire was applied to 143 mothers whose babies completed their first 2 months, who presented to the hospital for vaccination and who did not receive education about SBS as the control group (group B). The data were evaluated using the Statistical Program for Social Sciences (SPSS) 15.0 statistical analysis package program. Ethical approval was obtained from the local ethics committee (30.12.2009, 2785). The rate of the mothers who stated "yes" to the sentence "babies occasionally cry" which was one of the main messages of the education was statistically significantly higher in group A compared to group B (p=0.001). The rate of the mothers who stated "I agree" to the sentence "battering is harmful for babies" was statistically significantly higher in group A compared to group B (p=0.001). Conclusively, it was found that SBS prevention program education was permanent until the 2-4(th) month.

Battered child syndrome: Is India in dire straits?

Battered child syndrome, battered baby syndrome, shaken baby syndrome, non-accidental injuries of childhood, etc. are all variants of forms of child abuse that has many names but a single outcome – the child is injured at the hands of a caretaker, more often than not a close relative. Although there are clear guidelines in most developed countries as to what the clinicians should do if they suspect a case of battered child syndrome, no such specific streamlined guidelines exist in most of the developing countries including India. In India, the National Commission for Protection of Child’s Rights and the Indian Academy of Pediatricians have recently taken the initiative to educate pediatricians about child abuse and formulate policies on reporting. Although the pediatricians have woken up to the reality of child abuse, rest of the medical fraternity is yet to wake up to the fact that a big proportion of children in India are being battered and most go unnoticed and unreported. In India, there is a need for the medical and nursing educators, practitioners, policy makers, political and legislative wings of the society to get together and raise awareness, formulate specific guidelines regarding the management of a case of suspected battered child; who should investigate and how the investigation has to be done, how to ensure safe settings for at-risk children and facilitate permanent placement for children who cannot return home.

Battered baby with multiple epiphyseal separations: case report and review of literature

Multiple epiphyseal separation in battered baby syndrome is a rare occurrence. We report epiphyseal separations of proximal tibia and distal humerus along with femoral shaft fracture in a child of two and half years of age. In the course of clinical, laboratory, and radiological examinations, the child was diagnosed to be a case of battered baby syndrome. The child was treated and isolated from the mother, who was the culprit for battering the child. We believe, in any epiphyseal injury below 3 years of age, particularly when the distal humerus physis is involved, diagnosis of child abuse should be considered as an etiology.

Child Abuse‐Related Homicides in New Mexico: A 6‐year Retrospective Review

We retrospectively reviewed autopsy records at a statewide medical examiner's office in order to identify and characterize deaths due to child abuse. In a 6-year period in New Mexico, the medical examiner investigated 45 deaths determined to be child abuse-related. Decedents were predominantly male (68.9%), Hispanic White (53.3%), and all were 5 years of age or younger, with a median age of 1 year. Head injuries were the most common cause of death (44.4%), followed by battered baby syndrome (15.6%). Relatives were involved as alleged perpetrators in 80% of the cases, with the father most often implicated (36.1% of cases), and 88.9% of child abuse injuries resulting in death occurred in the family's residence. Toxicology was positive in 26.7% of cases, but only two cases had substances of abuse present. Information on risk factors such as prematurity, parental age, and history of abuse was also collected.

Battered baby syndrome with severe malrotation deformities of all long bones of lower extremities: A case report

Battered baby syndrome with severe malrotation deformities of all long bones of lower extremities: A case report

Child abuse; Denial and the implications for partnership

Since the first description of the ‘Battered Baby Syndrome’ appeared in the medical literature over forty years ago, our ability to recognise injuries caused by abuse has improved greatly. There is now a strong evidence base that allows doctors to reliably identify injuries caused by abuse. Similar evidence based advances in treatment and prevention, however, remain elusive. Our ability to predict risk and prevent abuse is poor and effective treatment strategies do not exist. Evidence from a review of inquests into fatal child abuse tragedies indicates that little new ever emerges and the tragedies continue. Evidence from covert video recordings has shown that partnership with abusers who mislead health professionals may be neither safe nor effective. Despite this, most current child protection procedures emphasise the importance of working in partnership with abusive families. Honesty is central to any meaningful partnership, yet denial is a prominent feature in many cases of abuse. The significance of denial is poorly understood and frequently underestimated. The current emphasis on partnership is not evidence based and may, by ignoring the significance of denial, place abused children in even greater danger. Evidence based principles must be applied to risk assessment and treatment strategies and the crucial question of denial addressed.

Histological demonstration of haemosiderin deposits in lungs and liver from victims of chronic physical child abuse.

In the context of chronic physical child abuse, two entities have been described based on macroscopical and radiological criteria: the battered baby syndrome and the shaken baby syndrome. However, in some autopsy cases, clinico-radiological information may not be available. In these cases, histological examinations are necessary to look for sequelae of repeated haemorrhages, particularly in organs likely to have suffered traumatisms such as the lungs, or in organs belonging to the mononucleated macrophage resorption system, such as the liver and the spleen. We examined a series of 15 young children who died from proven chronic child abuse and compared them with 15 sex and age-matched control subjects who died from natural causes with no history of child abuse. Using Perl's stain for iron, we identified haemosiderin deposits in pulmonary, hepatic and splenic samples and the deposits were evaluated qualitatively and quantitatively. Haemosiderin deposits were significantly (P < 0.001) more abundant in the lungs and liver of the chronic abuse victims than in those of the control subjects. However, they were not significantly more abundant in the spleens of child abuse victims than in controls. We conclude that haemosiderin deposits in lungs and liver could be proposed as a marker for chronic physical child abuse. This study stresses the importance of systematic histological examination to look for pulmonary and hepatic haemosiderin deposits in cases in which chronic child abuse is suspected.

Intravitreal tPA and SF 6 Promote Clearing of Premacular Subhyaloid Hemorrhages in Shaken and Battered Baby Syndrome

Child abuse is a serious problem in many cultures. The ocular signs of shaken baby include intraretinal, subretinal, and preretinal hemorrhages. The hemorrhages may be unilateral or bilateral and are seen in 50% to 80% of patients. Previous treatment was limited to observation or vitrectomy, but some observed eyes develop amblyopia, and pediatric vitrectomy has many complications. We report 4 eyes in 2 children with shaken baby syndrome in whom we administered intravitreal tissue plasminogen activator (tPA) in an attempt to resolve preretinal hemorrhages earlier than observation alone without the complications of vitrectomy. The tPA dose ranged from 12.5-25 microg per injection. Eyes were injected once weekly for 3 consecutive weeks. Each time 0.25 cc of sulfur hexafluoride gas was also injected. Within 1 week following the last tPA administration, complete resolution of the preretinal hemorrhage was seen. There were no associated ophthalmic complications. Intravitreal tPA with an expansive gas is an alternative method to observation or vitrectomy for resolution of preretinal hemorrhages in battered babies and may allow faster resolution of hemorrhages without the complications of vitrectomy.

A diagnostic dilemma in Jordan: Two child abuse case studies

The prevalance of child abuse in Jordan is not known, and the criteria of nonaccidental injuries in Jordanian children are not well defined. Our experience in the pediatrie as well as the psychiatric clinics suggests that the problem of child abuse is not rare. The issue of child abuse in Jordan is a sensitive one, in view of the sequelae of misdiagnosis and absence of clear policy regarding the assessment and management of abused children and their parents. This is the first report of child abuse of Jordanian children who manifested clinical and radiological features of the Battered Baby Syndrome. Earlier identification and intervention could have prevented the serious sequelae in these two cases. A higher index of suspicion for the possibility of child abuse (nonaccidental injuries) among Jordanian children with injuries is warranted.

Social aspects of the battered baby syndrome.

In spite of increasing interest, the problem of the battered child remains controversial. Some see the problem as a response to stressful social circumstances and society's permissive attitude to violence (23), others view it as primarily a manifestation of parental maladjustment (64).