Frequently Asked Questions About Child Injury Law

Yes.  Daycare providers are required by law to report signs of child abuse to child protective services.  Bruising in infants is always concerning.  Especially infants who are not able to move on their own yet - meaning they are too young to roll, crawl or walk.  Even toddlers who cruise can have bruising which is very suspicious.  If the daycare providers saw bruising which should have caused them to be suspicious - and it sounds like they were since they asked you about it - it should have ben reported to child protective services (CPS).

You may contact the Federal Bureau of Investigation (FBI), National Center for Missing and Exploited Children, U.S. Department of Justice - Child Exploitation and Obscenity Section, your local police department special victims unit and the U.S. Postal Service.  Here is a link to a website that explains how to report child pornography to legal authorities: http://www.justice.gov/criminal/ceos/childporn.html

Some of the causative agents that can cause decreased level of consciousness or coma in children include alcohol, acetaminophen, barbiturates, benzodiazepines, carbon monoxide, caffeine, chloral hydrate, chlorpromazine, dihydrocodeine, ethylene glycol, flunitrazepam, gamma hydroxyburate, heroin, insulin, phenytoin, pine oil, sedatives, water intoxication and salt.  

Yes, bleeding in the head can cause fever. So it is possible that a child will have a fever as part of the symptoms of head trauma. It is important to remember that fever is consistent non-accidental or abusive head trauma (otherwise known as shaken baby syndrome).   

Healthcare providers should look for clinical findings such as bruises, contusions, abrasions and lacerations to the head. The scalp should be evaluated for bogginess or swelling. If swelling is present the injury is recent. If a skull fracture is present with no or minimal swelling, the injury may be older. Healthcare providers should also check for blood behind the tympanic membrane which may indicate a basilar skull fracture. Obvious trauma involving the outer ear structures are indicative of abuse and are known to rarely occur accidentally. Subconjuctival hemorrhage or petechiae are consistent with strangulation or blunt trauma. However, retinal hemorrhages are consistent with abusive head trauma and an ophthalmology consult should be ordered for better visualization and evaluation of the retinas. A provider should assess for dried blood in the mouth, on the lips, and nose.  Injuries to the oral mucosa, including tongue, gums, and frenula of the tongue and lips are indicative of blunt trauma or suffocation injuries. Tears of the fenulum are indicative of forced objects in the mouth, like a pacifer, bottle or toys. These types of injuries are created by excessive force to the tissues and may indicate force into the oral mucosa (to stop an infant from crying) prior to shaking or abusive head trauma.  

In general, abusive head trauma outcomes are worse than outcomes for accidental head trauma in children. For accidental head trauma, 55% of victims will have a good recovery. For non-accidental head trauma victims, up to 25% of children will die from their injuries. And for the survivors, approximately 65% of non-accidental head trauma victims will have residual disabilities ranging from mild to severe. Meaning 65% of victims will suffer from permanent cognitive and physical disabilies. In general, even children with mild non-accidental head injuries suffer long-term cognitive and behavioral impairments.  

For children with head injuries a CT scan of the head, magnetic resonance imaging (MRI) and ophthalmological consultation should be ordered. Other tests may be ordered based on the physical findings and history obtained during the examination.    

The healthcare provider that suspects a child may have injuries consistent with non-accidental trauma should consider ordering a CT and/or MRI of the head, skeletal survey, genital and skin examination, head-to-toe physical examination with documentation of growth parameters, liver and pancreatic enzyme levels, urinalysis, complete blood count, clotting studies, dentistry and ophthalmological consultation and imaging studies of the chest/abdomen and pelvis.

According to officials in multiple states that suffered increases in instances of child abuse while simultaneously seeing higher unemployment rates, the answer is believed to be yes.  The most recent state expressing concern is Florida:  according to Fox News, approximately 200 children died from abuse in Florida in 2008, which is about 20 percent more than the statistic from 2007.  According to experts, the "sour economy" contributed to the rise in child abuse cases, specifically those of shaken baby syndrome.  In 2008, the unemployment rate in Florida jumped from 4.1 % to 6.2 %, meaning that approximately 339,600 jobs were lost.  The link?  The most common abusers are unemployed men (between the ages of 18 and 30) who watch children while the mother is at work.  With more unemployment came more cases of shaken baby syndrome and other types of abuse.  Among the most common triggers of abuse are crying, feeding, and toilet training, often triggers that lead to a caregiver shaking a baby.  For these unemployed, non-biological males, the lack of parenting knowledge and skills results in frustration and the inability to cope with common infant actions like crying.

As a shaken baby syndrome attorney and father of two, Chris Keane works as an advocate for victims of child abuse.  Although nothing can compensate for the tragic and indescribably difficult loss of a child, certain measures can be taken to help surviving family members as they go through the grieving process.  For more information on shaken baby syndrome, wrongful death, and how you can receive free help during your time of need, contact Chris Keane of the Keane Law Firm.

You may contact Chris Keane online or call 1-888-592-KIDS (1-888-592-5437).

Experts determine causes of head trauma within the context of comprehensive data collection, including thorough history and clinical evaluation. There are differences in the frequency of certain types of injury patterns and clinical evidence in abuse and accidental cases. Literature supports there is a greater frequency of complex intracranial injuries in abuse cases versus accidental cases. Epidemiologic studies show infants and children fall commonly and this rarely results in complex head injury patterns. Motor vehicle crashes more commonly cause head injuries in children due to acceleration-deceleration and sudden deceleration mechanisms. Child death from a short fall is rare and should prompt investigation into possible child abuse.