How an injury on a child could be an opportunity for intervention

In the past six months, both the Davidson County and Davie County Departments of Social Services (DSS) have seen dramatic influxes of child physical abuse case reports. In fact, Davidson County DSS set a record for the month of August for the number of reported physical abuse cases. Due to this increase, The Dragonfly House has experienced a 120% increase in physical abuse cases seen here when compared to the same time period as last year.

Several staff members, along with two Davidson County detectives and three Davidson and Davie County social workers, recently had the opportunity to attend a physical abuse simulation in Chapel Hill along with other Children’s Advocacy Center health care providers, Child Protective Services social workers and detectives from throughout the state. All attendees have experience working with child abuse cases within their communities.

The focus of the training was physical abuse in children two years of age and younger. These are our most vulnerable population because they lack the verbal skills to provide details of what has happened to them. In addition, there may be no witnesses to the events happening and the family dynamics might prevent family members talking about their suspicions of other family members.

In our training, the main topic was “sentinel” injuries. Sentinel injuries are previous injuries of children that may precede a future non-accidental trauma or even death. These types of injuries may be a bruise on the face, ears, back, upper arms or upper legs, trauma to the mouth or a broken blood vessel in the eye. Sentinel injuries are sometimes seen as warning signs of impending traumatic injuries.

sentinel injuries 5

When health care providers are presented with sentinel injuries, the recommendations for additional testing are skeletal surveys, head scans, eye exams and comprehensive blood work. Skeletal surveys and head scans might show healing fractures indicating previous breaks in the bones. Head scans could also reveal soft tissue swelling in the brain which might be sign of a child being shaken. Eye exams may uncover retinal hemorrhages from a child being punched or slapped in the area of the eye. Blood work rules out any blood disorders that could cause excessive bruising or might even indicate irregularities that point to an abdominal punch or kick to the liver or pancreas.

Our training took each group through a scenario that involved several, different sentinel injuries of a child that had previously been missed by multiple healthcare providers in various healthcare settings. We were able to see the differences in the roles of detectives and social workers and the questions they ask. However, the primary goal for all of us was the safety of the child. Each group worked together as multidisciplinary teams to make recommendations on whether to bring charges against one of the parents and the safest place for the child to live. At the end of the training, we were brought together to discuss the different recommendations from all of the groups which were all very similar. Two Assistant District Attorneys then discussed the court process once charges were filed.

While we all gained significant knowledge of the responsibilities that each discipline provides in the investigation of child abuse cases, the most significant lesson learned from our training was for all of us to remain mindful of sentinel injuries in children 2 years of age and under and the role these injuries might play in children’s futures. Sometimes injuries that seem insignificant could actually be opportunities for intervention and may save children’s lives.

Daughn Eagan, RN, BSN
Medical Coordinator
The Dragonfly House Children’s Advocacy Center

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