Investigation requires considerable tact and experience and should be left to those suitably qualified. Consult your local authority policy document on child abuse. Subsequent liaison with the hospital is important such that follow up can be made in the event of non-attendance. Advice can also be sought from the social services and from the N.S.P.C.C.
HISTORY:
1. - inadequate explanation of injury and delay in seeking medical advice for injuries.
2. - frequent visits for medical advice – possible a cry for help.
3. - known or suspected previous child abuse.
4. - inappropriate or disturbed parental behaviour.
SIGNS:
PSYCHOLOGICAL:
1. - silent hyperalertness, an inhibition of natural behaviour. "Frozen awareness". Tense rigidity in adult presence.
2. - behavioural activity may range from hyperactive "naughtiness" to withdrawn apathy.
3. - many show demanding, "clingy" behaviour in an attempt to gain greater mothering.
PHYSICAL:
1. - skin injuries present in over 90% of cases, but neglect and deprivation can occur without other signs of maltreatment.
2. - height, weight, cleanliness, general care and clothing.
3. - lesions of various vintages.
4. - location of injuries – accidental bruising tends to be random in both size and shape and located over bony prominences such as shins, knees, forehead, etc.
5. - some of the more common characteristic injuries are listed below:
- fingertip bruising, commonly on face – facial squeezing – grip marks, pinch marks, bites and cigarette burns – frenum tearing – signs of violent bottle feeding – petechial haemorrhage on ear lobes (blue spotted ear) – other bodily injury such as immersion scalds.
REMEMBER TO SEEK ADVICE:
Aggressive questioning of parent and involvement of the Police is counterproductive.