Battered child syndrome (Cafey’s syndrome, the maltreatment syndrome)

 

Battered child syndrome (Cafey’s

syndrome, the maltreatment syndrome)

Most of the children are below the age of three years.

The incidence is seen slightly more in boys.

Position in the family: Usually there is only one child in the family who may be

 youngest or eldest and is often unwanted who may be born before marriage, due to

 failure of contraception and is usually an illegitimate child.

Nature of injuries:

The areas most affected are head, face, and neck. Bruising of scalp and forehead and

 underlying skull and brain injuries are produced that is visible on autopsy.

Bruising of external ear, cheeks, and the lips especially the upper lip associated with

 laceration of frenu­lum is of diagnostic significance. The detach­ment of inner

 surface of the lip from the gum margin suggests punching or slapping of the mouth

. Bruising of the neck and sides of the chest may reveal fingertip pressure marks.

 The neck may be held on each side in turn to immobilize the face while it is

 assaulted with the other hand, leaving symmetrical bruises beneath the angle of the

 jaw. The rupture of abdominal viscera may occur and externally the classical six

 penny piece bruises extending from the breastbone to the pubis are seen.

Bites: The bites are very commonly produced by the mother that is to be

 differentiated from the bites by other children.

Eye injuries: The injuries to the eye that are found in battered baby syndrome are

 retinal separation, lens displacement, subconjunctival, sub hyaloid and retinal

 haemorrhages.

Head injuries: Head injuries are common in a battered child. There may be

 presence of exter­nal scalp injuries.

Visceral injuries: Rupture of liver, intestine, and mesentery account for most of the

 fatalities due to blows over front of abdomen.  Skeletal lesions and radiologic

 appearances:

In all the cases of battered baby syndrome, radio­graphy is most important. A whole-

body X-ray must be performed before autopsy.

It provides two kinds of useful information about general skeletal damage especially

 of various times of infliction and the characteristic bony lesions.

The sub periosteal calcification in periosteal haemorrhages is a characteristic

 feature. There are multiple frac­tures of ribs that show a beading effect.

Burns: Punctate burns often accompanied by older scars may indicate deliberate

 stubbing of cigarette ends upon child’s skin. Child may be seated upon a stove or

 electric radiator and may be dipped in hot fluids.

Tardieu's Spot: It is named after Auguste Ambroise Tardieu, who was a French

 forensic medical scientist. It is sub pleural spots of ecchymosis that follow the

 death of a newborn child by strangulation or suffocation. He was the first to

 describe the clinical features in the battered children. Therefore, battered child

 syndrome is also known as Tardieu's syndrome.

Diagnosis

There is inconsistency of parent’s explanation with the extent and chrono­logy of

 injury. The bruises are multiple and there are multiple fractures in various stages of

 healing.

There is delay in seeking medical advice or treatment. This is a highly significant

 feature that is seeking medical advice and injuries have a long interval.

Classic lesions such as torn upper lip frenu­lum, multiple bruises on the face, thorax,

 or abdomen and around joints of the limbs, bite marks, unusual burns, and

 fractures in various stages of healing and multiple bruises with distinct colours are

 typically present.

There is evidence of repeated visits to different doctors or different medical centers.

#battered baby syndrome #Cafey's syndrome