Abstract Ref Number = APCP1259
“SILENT WARNING SIGN” MEDICOLEGAL APPROACH TO CHILD PHYSICAL ABUSE CASE REPORT
NIA KANIASARI DEFININGSIH,ARYA PUTRA SYUHADA
GENERAL HOSPITAL OF KARAWANG HERMINA GRAND WISATA HOSPITAL
Background : Indonesian Child Protection Commission (KPAI) stated that child abuse always increases every year, from 2011 occurred in 2178 cases to 2014 there were 5066 cases. Children are very sensitive to the violence, high incidence of child abuse the responsibility of the government, parents, community and including health worker. Reporting the case to judicial authorities and the correlation of medical examination findings with medico legal history are other important steps. By presenting this case, we aimed to increase the awareness level of physicians working in hospital emergency for performing adequate approaches for suspected cases of child abuse
Case Presentation Summary : A 15 months old girl admitted to emergency room with recurrent seizures and loss of consciousness. Physical examinations are: Glasgow Coma Scale was E1M2V1 and her general condition was weak. Her vital sign are: heart rate tachycardia, temperature 36.1?C respiration rate less than 10 times/minute then do intubation and ventilator installation. The other of physical examination was found: abrasions on both eyelids, symmetrical pupil diameter, positive pathological reflex to the right extremity, large number of purple and yellow bruises and scars had been identified around chest wall, both of arms, both of legs and back. The first medical history taken from her mother and the mother of her mom boyfriend in the hospital while they were together. Both people also stated that the child fell from bed. She added that she could not say the truth in the first forensic interview because of being threatened by her boyfriend, but after interrogation by the police been exposed that the abuser is her mother.
Learning Points/Discussion : Management of child abuse to cover all aspects of medical, psychological, and medicolegal. Medical procedures include emergency management, injury, and infection. When a physician suspects physical child abuse, it is important to perform proper clinical approach in suspected cases of child abuse, primary medical approach is to perform lifesaving medical urgently. As seen in the present case, obeying universal clinical forensic medicine principles such as interviewing with the patient or witness alone was important to the appropriateness of the forensic investigation. In the present case, another important observation was that the forensic history of the witness was not always reliable, hence practitioners must have high awareness levels about detecting child abuse case claimed to have occurred because of accidental injury. In living cases of suspected abuse, detailed internal and external examinations must be conducted. Medical documentation should be recorded including all the history and findings on examination, and to do a thorough study of the medical records in order to provide scientific opinion regarding the diagnosis and medical condition of the child in an objective and unbiased. Parents must be informed about the possibility of abuse in children and the need to report to the child protection agency. Law enforcement will investigate criminal cases in children, so the police will be involved in some cases, suspected of being mistreated in children
Keywords: child abuse medicolegal