Sound Medicine -- September 7, 2002

Barbara Lewis and Dr. Ora Pescovitz talk to physicians and experts about:

Child abuse and the medical community
Medical imaging to detect child abuse

Child abuse and the medical community

In Indiana last year, 45 children died of abuse. The majority of those children were three years old or younger. But many more children survive abuse, and one of the places it is discovered is the hospital emergency room. This week we examine how the medical community responds to cases of abuse.

Roberta Hibbard, MD, specializes in diagnosing cases of child abuse. She describes research she's done comparing drawings of children who've been abused with those of other children.

Dr. Hibbard reports that in Indiana, 50,000 cases of child abuse are reported each year. Half of these are substantiated. Only 5% of children involved are actually removed from their parents' care. Instead parents are trained in parenting skills; drug or alcohol treatment may also be necessary.

As a physician, Dr. Hibbard tries to be objective when determining if a child's trauma is medical, accidental, or non-accidental. She stresses the importance of physicians getting good information from parents and to be thorough in an exam. Abuse detected by a doctor by law must be reported to Child Protective Services. Dr. Hibbard says doctors should be aware of diseases that might present like child abuse. She also emphasizes the importance of a local support-structure for parents.

Dr. Roberta Hibbard is a professor of pediatrics at the Indiana University School of Medicine. She specializes in helping detect and treat cases of child sexual abuse; physical abuse; Munchausen syndrome by proxy and child neglect. She educates police and other government workers in diagnosing child abuse.

Resources

Prevent Child Abuse Indiana Web site has information on the prevention and intervention to keep children safe.

Information about Child Protective Services in Indiana including a hotline phone number to report suspected cases of abuse.

MedLine Web site is a clearinghouse of top information and links to information about abuse and neglect issues and links to recent research in the area of abuse and psychological development.<

Medical imaging to detect child abuse

Continuing our discussion of child abuse, we talk with pediatric radiologist Kimberly Applegate. She explains how X-rays and other imaging techniques can detect past and present abuse injuries.

If a child has a suspicious broken bone, Dr. Applegate will do a series of 17 X-rays, or radiographs, to look for evidence of other breaks, or of earlier injuries. A suspicious break might be a serious fracture of a leg bone in a child who does not yet walk. Dr. Applegate describes other tests, such as a nuclear bone scan, which detects subtle fractures. A CAT scan can reveal bleeding or bruising on the brain, or injured internal organs. An MRI can determine subtle head or spinal injuries.

Dr. Applegate explains the pioneering work of radiologists in detecting child abuse and how pediatric radiologists are specially trained to diagnose it. She also lists ways the medical community can improve detection of child abuse, such as doing routine radiography of children who die under the age of three. Dr. Applegate says the role of radiology is not only to provide medical help but legal evidence.

Dr. Kimberly Applegate is professor of pediatric radiology at the IU School of Medicine.

Resources

A digital library of common pediatric conditions, the Web site Pediatricradiology.com has information for medical professionals and information for parents.

An overview article from the American Academy of Pediatrics discusses the role of imaging in identifying cases of child abuse.

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"Shortly after Sept. 11, many people seemed to be re-evaluating their lives regarding family relationships and romantic involvements," Billingham said. "However, as time goes by -- except for those directly affected by the attacks -- we seem to be reverting back to our old habits and ways."

But Dr. Billingham goes on to say that this type of behavior is completely normal, and, in fact, a healthy response. "It's human nature to become more aware of our mortality and connectedness to others [after such a tragedy]. This makes us feel safe and secure, which is then what causes us to revert back to our interest in self and resume our mundane lives. Otherwise, people remain overwhelmed by tragedy and never move forward psychologically."