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Inform child protective services
91%
10/11
Provide parents with anticipatory guidance
0%
0/11
Provide home nursing visits
Reassurance that accidents are common
Referral to genetics for further testing
9%
1/11
Select Answer to see Preferred Response
In this scenario, the child most likely has suffered from "shaken baby syndrome" due to the presence of bruises, retinal hemorrhages, and subdural hemorrhage. The duty of the physician is to inform child protective services. The fact that infants usually cannot roll at 3 months of age increase the probability child abuse, in that the child did not likely roll off the couch. More than 40 percent of deaths from child abuse occur in infant younger than 12 months of age. Head injury is the most common cause of death. Commonly seen injuries include retinal hemorrhages, cutaneous bruising, rib fractures, and long bone fractures. Management depends on the medical issue and requires evaluation for occult injuries. Consultation with other specialists and social workers is recommended. The safety of the child is first and foremost and must be reported to Child Protective Services. Castiglia et al. provides a review of shaken baby syndrome and the cause of extreme rotational cranial acceleration from violent shaking or impact. While it is mostly seen in children under 2 years of age, it can be seen in children up to 5 years old. It is important to devote more resources to the detection and prevention of shaken baby syndrome and other forms of child abuse. In a meta-analysis, Piteau et al found that clinical findings strongly associated with abusive head trauma include inadequate history, apnea or seizures on presentation, fractures of the ribs, metaphyseal region, or long bones, retinal hemorrhages, subdural hemorrhage, skull fracture with associated intracranial injury, and cerebral ischemia on neuroimaging. With various findings, there is an attempt to identify consistent criteria in reporting the findings of abusive head trauma as well as nonabusive head trauma. Incorrect answers: Answer 2: Anticipatory guidance is usually provided at the well child visits, but this child has a more pressing concern of abuse. Answer 3: While home nursing visits can help the parents, there is no sign that these visits will address suspicions of abuse. Answer 4: Reassurance is not indicated, particular since there are many present warning signs of child abuse. Answer 5: Referral to genetics is not needed at this time.
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