As a parent and as a medical doctor, I consider just one case of missed pediatric physical abuse as a
travesty. However, the sad state of affairs is that hundreds of children go through the formal hospital
system in Kenya and abuse cases continue to be missed by professionals in our collective healthcare
system. A small but significant number of these children die each year as a result of physical abuse by
adults or other older children.
To put this into context, data from the US shows that 20 – 30% of children who die from physical abuse
and neglect, had previously been treated in a hospital somewhere along the line for those injuries, without
recognizing them as such.
Healthcare professionals and parents/guardians have to work hand in hand to get better at identifying
these victims while there is still something that can be done. It is, therefore incumbent on us as those
responsible for children’s wellbeing to maintain a healthy vigilance around this issue. This is because it
will often present in the most unexpected of ways.
Case Study on Child Abuse
“A four-month-old, otherwise healthy baby boy is brought to the hospital by his mother with the chief
complaint of diarrhea. The child has no fever, no vomiting, no history of travel, no change in diet, and
diarrhea seems relatively severe, from the story that the mother gives to the doctor. The doctor then pulls
up the baby’s onesie to examine him only to find a red bruise on his tummy. The bruise is small in size
but is visible. The doctor asks the mother how the baby got the injury, and the mother says she does not
know. The doctor then proceeds to investigate and treat diarrhea with little regard for the bruise, and the
child is subsequently discharged without much ado. This child would not raise any red flags in most
clinics/medical outpatient departments.”
The above case is an excellent example of what we in the medical field would refer to as a “sentinel
injury.” Such bruises are particularly rare in infants who are yet to start moving around by themselves.
One must always dig deeper upon finding such an injury.
For doctors, it is essential to note that such patients are often brought in for a separate and often
insidious reason. Therefore, you must rely on your professional instinct and reading of the situation to
diagnose this issue correctly.
According to a research study conducted by my favorite online medical resource Medscape, the most
common type of sentinel injury in children who were abused was; bruising (80%), followed by intraoral
damage (11%) and other injuries (7%).
Sentinel injuries were found to occur during early infancy mostly. The researchers say 66%, at younger
than three months of age and 95% by the time they had reached seven months of age. These injuries
may seem minor on appearance but have major significance. This is because they present us with an
opportunity to intervene before the abuse progresses to more severe outcomes.
I know what everybody is thinking at this point – how do I keep my child safe? There is no simple answer
to this question. The best bet is to learn what the signs abuse look like, so you can stay on top of your
child’s wellness throughout their growth.
It is essential to understand that the profile of a potential abuser is not standard; they can be male or
female, they can be domestic workers or family members (even including a parent/grandparent)
How can a parent hurt their child?
It may seem unthinkable that this could happen. Note! It is not my intention to cast aspersions but rather
to enlighten parents on the possible threats to their children’s health. For example, have you ever heard of baby blues? Baby blues is the casual term for postpartum depression in women, which is an
identifiable medical condition that, if untreated, can tip the patient over the edge.
Spouses and other family members should keep an eye on a new mother who seems not be taking care
of their personal hygiene, seems disinterested in their newborn, spends undue periods in bed, and other
out of the ordinary behavioral changes. Such an individual can end up hurting their child if unchecked.
Keep in mind that abuse is a cycle and tends to progress to more serious outcomes if left unchecked.
What begins as bruises can very well advance to eye or tongue injuries, unexplained fractures, and even
Abuse in childhood can lead to serious long term implications in adulthood. About one-third of adults
globally have suffered one form of abuse during their life by the time they reach adulthood. Child abuse is
a problem of massive public health proportions, which impacts on the mental and behavioral health of
The role of our facility
As a healthcare facility, MedLux International shall be interested in the holistic wellbeing of all our
patients, both adult and pediatric. In the ongoing training and onboarding of all our clinical staff, we have
empowered our teams to speak out.
It is not restricted to just the doctors. If a nurse, a lab technologist, or a Pharmacist suspects abuse, they
are empowered to report the same using our internal Child Abuse Reporting System, which will enable us
to make the necessary interventions to prevent awful outcomes.
What role can you play as parent/uncle/aunt/brother/sister/friend?
Next time you observe something not quite right on a little prince or princess, ask questions!
Look out for:
- Bonks (Head injuries)
- Breaks (Fractures)
No child is immune to abuse – it affects children of all ages, races, and socio-economic backgrounds.
Let’s work together.