Dr Vijay Kundal
Definition
Battered baby syndrome is defined as non-accidental injuries sustained by a child as a result of physical abuse, usually inflicted by an adult caregiver. Internal injuries, cuts, burns , bruises , and bony fractures are all possible manifestations of battered baby syndrome. Because adults are so much larger and stronger than children are, the victim can suffer severe injury or death without the abuser intentionally causing such an injury. Shaking an infant can cause bleeding in the brain ( subdural hematoma ), resulting in permanent brain damage or death. Emotional damage to a child is also often the byproduct of child abuse , which can result in the child exhibiting serious behavioral problems. Battered baby Syndrome is alternatively referred to as child physical abuse or non-accidental trauma.
Causes and symptoms
Battered baby syndrome is found at every level of society, although the incidence may be higher in lower-income households, where adult caregivers may suffer greater stress and social difficulties and have a greater lack of control over stressful situations. Other risk factors include lack of education, single parenthood, and alcoholism or other drug addictions. The child abuser most often injures a child in the heat of anger or during moments of stress. Common trigger events that may occur before assaults include incessant crying or whining of infants or children; perceived excessive “fussiness” of an infant or child; a toddler’s failed toilet training ; and exaggerated perceptions of acts of “disobedience” by a child. Sometimes cultural traditions may lead to abuse, including beliefs that a child is property, that parents (especially males) have the right to control their children any way they wish, and that children need to be toughened up to face the hardships of life. Child abusers were often abused as children themselves and do not realize that abuse is not an appropriate disciplinary technique. Abusers also often have poor impulse control and do not understand the consequences of their actions.
Presentation
Symptoms may include a delayed visit to doctor with an injured child; an implausible explanation of the cause of a child’s injury; bruises that match the shape of a hand, fist or belt; cigarette burns; scald marks; bite marks; black eyes; unconsciousness; lash marks; bruises or choke marks around the neck; circle marks around wrists or ankles (indicating twisting); separated sutures; unexplained unconsciousness; and a bulging fontanel in small infants. Emotional trauma may remain after physical injuries have healed. Early recognition and treatment of these emotional “bruises” is important to minimize the long-term effects of physical abuse. Abused children may exhibit: a poor self-image, an inability to love or trust others, aggressive, disruptive, or illegal behaviour. anger, rage, anxiety , or fear , sadness or other symptoms of depression.
Sometimes emotional damage of abused children does not appear until adolescence or even later, when abused children become abusing parents who may have trouble with physical closeness, intimacy, and trust. They are also at risk for anxiety, depression, substance abuse, medical illnesses, and problems at school or work. Without proper treatment, abused children can be adversely affected throughout their life.
Diagnosis
Battered baby syndrome is most often diagnosed by the doctor or by teachers or social workers. Physical examination will detect injuries such as bruises, burns, swelling, retinal hemorrhages (bleeding in the back of the eye), internal damage such as bleeding or rupture of an organ, fractures of long bones ore spiral-type fractures that result from twisting, and fractured ribs or skull. X rays , and other imaging techniques, such as MRI or scans, may confirm or reveal other internal injuries. The presence of injuries at different stages of healing (i.e., having occurred at different times) is nearly always indicative of Battered baby syndrome. Establishing the diagnosis is often hindered by the excessive cautiousness of caregivers or by actual concealment of the true origin of the child’s injuries, as a result of fear, shame and avoidance or denial mechanisms.
Treatment
Medical treatment for battered child syndrome will vary according to the type of injury incurred. Counselling and the implementation of an intervention plan for the child’s parents or guardians are necessary. The child abuser may be incarcerated, and/or the abused child removed from the home to prevent further harm. Decisions regarding placement of the child with an outside caregiver or returning the child to the home will be determined by an appropriate government agency working within the legal system, based on the severity of the abuse and the likelihood of recurrence. Both physical and psychological therapy are often recommended as treatment for the abused child. If the child has siblings, the authorities should determine where they have also been abused, for about 20 percent of siblings of abused children are also shown to exhibit signs of physical abuse. The prognosis for battered baby syndrome will depend on the severity of injury, actions taken by the authorities to ensure the future safety of the injured child, and the willingness of parents or guardians to seek counseling for themselves as well as for the child.
Prevention and parental concerns
Recognizing the potential for child abuse and the seeking or offering of intervention, counseling, and training in good parenting skills before battered child syndrome occurs is the best way to prevent abuse. The use of educational programs to teach caregivers good parenting skills and to be aware of abusive behaviors so that they seek help for abusive tendencies is critical to stopping abuse. Support from the extended family , friends, clergy, or other supportive persons or groups may also be effective in preventing abuse. Signs that physical abuse may occur include parental alcohol or substance abuse; high stress factors in the family life; previous abuse of the child or the child’s siblings; history of mental or emotional problems in parents; parents abused as children; absence of visible parental love or concern for the child; and neglect of the child’s hygiene. Parents who are in danger of abusing their children (for example, when they find themselves becoming inappropriately or excessively angry in response to a child’s behavior) should seek professional counseling. through a parenting or caretaking crisis and offered guidance about how to better handle the situation. Parents should also exercise caution in arranging for or hiring babysitters and other caretakers. If they suspect abuse, they should immediately report those suspicions to the police or to their local child protective services agency. They should also teach their children to report abuse to a trusted adult.
(The author is Consultant Neonatal & Pediatric Surgeon at Dayanand Medical College & Hospital, Ludhiana)
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