The posterior ribs are the most common area of nonaccidental rib fractures.
Suspect head injuries and possible abuse if the child has unexplained seizures, vomiting, changes in neurological or mental status, or large scalp hematomas. Be suspicious if the parents’ explanation changes over time, if there is intracranial bleeds after "minimal" trauma, or if you find retinal hemorrhages outside of the newborn period, she said.
Myth: Sexual abuse leaves physical findings. More myths: A colposcope is needed to detect sexual abuse, and some girls are born without hymens.
Although hymens come in a wide variety of shapes and sizes, a study of more than 1,100 newborn girls showed that all of them had one, she noted. Reviews of cases of sexual abuse show that physical exam findings of pediatric sexual abuse are rare because the tissue is very elastic and heals quickly.
Physical evidence will be more likely if force was used, if the child resisted, if there are great differences in the sizes and ages of the perpetrator and victim, and if a foreign object was forced into the mouth, vagina, or anus. Bruising or bite marks on a child’s penis may suggest nonaccidental trauma from forced toilet training.
When you see visible clues to what may be abuse, photograph or draw what you see and include something in the image to show size or scale. Don’t just rely on written notes, she said.