Definition

Battered child syndrome refers to injuries sustained by a child as a result of physical abuse, usually inflicted by an adult caregiver. Alternative terms include: shaken baby; shaken baby syndrome; child abuse; and non-accidental trauma (NAT).

  Description

Internal injuries, cuts, burns, bruises and broken or fractured bones are all possible signs of battered child syndrome. Emotional damage to a child is also often the by-product of child abuse, which can result in serious behavioral problems such as substance abuse or the physical abuse of others. Approximately 14% of children in the United States are physically abused each year, and an estimated 2,000 of those children die as a result of the abuse. Between 1994-1995, 1.1 million cases of child abuse were recorded in the United States; of that number, 55% of the victims were less than a year old.

  Causes and symptoms

Battered child syndrome (BCS) is found at every level of society, although the incidence may be higher in low-income households where adult caregivers suffer greater stress and social difficulties, without having had the benefit of higher education. The child abuser most often injures a child in the heat of anger, and was often abused as a child himself. The incessant crying of an infant or child may trigger abuse. Symptoms may include a delayed visit to the emergency room 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; bruises around the neck; and a bulging fontanel in infants.

  Diagnosis

Battered child syndrome is most often diagnosed by an emergency room physician or pediatrician, or by teachers or social workers. Physical examination will detect bruises, burns, swelling, retinal hemorrhages. X rays, and other imaging techniques, such as MRI or scans may confirm fractures or other internal injuries. The presence of injuries at different stages of healing (i.e. having occurred at different times)is nearly always indicative of BCS. Establishing the diagnosis is often hindered by the excessive cautiousness of caregivers or by actual concealment of the true origin of the child3s 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. Counseling and the implementation of an intervention plan for the child's parents or guardians is necessary. The child abuser may be incarcerated, and/or the abused child removed from the home to prevent further harm. Reporting child abuse to authorities is mandatory for doctors, teachers, and childcare workers in most states as a way to prevent continued abuse. Both physical and psychological therapy are often recommended as treatment for the abused child.

  Prognosis

The prognosis for battered child 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

Recognizing the potential for child abuse in a situation, and the seeking or offering of intervention and counseling before battered child syndrome occurs is the best way to prevent it. Signs that physical abuse may be forthcoming include parental alcohol or substance abuse; 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; child's hygiene neglected.

   Key Terms:

Fontanel Soft spot on top of an infant's skull. Subdural hematoma Bleeding over the brain. Multiple retinal hemorrhages Bleeding in the back of the eye.

   Resources:

Books

• Lukefahr, James L. Treatment of Child Abuse. Baltimore, MD: Johns Hopkins University Press, 2000.
• Helfer, Mary Edna, Kempe, Ruth S., and Krugman, Richard D. The Battered Child, 5th ed. Chicago,IL: University of Chicago Press, 1997.

Periodicals

• Mulryan, Kathleen, "Protecting the Child." Nursing (July 2000)

Organizations

• Childhelp National Abuse Hotline. (800)422-4453.