Whatexamination findings are indicative of non-accidental or child abuse injuries to the head of a child?
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.