PubMed · 3381850
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D M Amadeo. 1988. A time for tears.. https://pubmed.ncbi.nlm.nih.gov/3381850/
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Ambroise Tardieu was an outstanding French forensic physician of the 19th century. A century before American physicians discovered child abuse as a pediatric and public health problem, Tardieu studied and described almost all forms of child maltreatment. In his "Dictionnaire d'hygiene et de salubrite" (Dictionary of hygiene and salubrity, 1862a, 1862b), Tardieu described the terrible working conditions of children in factories and mines. He also reported the ill consequences of theses conditions on the children's physical and mental health. In his "Etude medico-legale sur les attentats aux moeurs" (Forensic study on offenses against morals, 1857), he analyzed 632 cases of sexual abuse in females (mostly children) and 302 cases in males, describing physical signs according to the severity of the abuse. His "Etude medico-legale sur les sevices et mauvais traitements exerces sur des enfants" (Forensic study on cruelty and the ill-treatment of children, 1860) is a classical description of the battered-child syndrome. Thirty-two cases, 18 of which resulted in death, are described in detail. He also published "Etude medico-legale sur l'infanticide" (Forensic study on infanticide, 1868), a book of his observations on infanticide, based on the study of 555 cases, of which 60 are discussed in detail. Unfortunately, Ambroise Tardieu was unable to convince the physicians of his time of the prevalence of the maltreatment of children in their own family. Furthermore, his successors in forensic medicine did not believe children's allegations of physical and sexual abuse. Child victims were condemned to suffer abuse and neglect for another century without the support of the medical community, despite the fact that a clear-sighted and renowned physician devoted a significant part of his career to trying to open the eyes of physicians and society to this horrendous reality.
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PURPOSE: The aim of this study was to assess the risk of child abuse in children younger than 18 months admitted to a pediatric trauma service with lower extremity injuries. METHODS: An Institutional Review Board-approved retrospective case series of children admitted to a regional pediatric trauma center with lower extremity injuries from 1998 to 2002 (n = 5497) was performed. Factors analyzed included age, injuries, and injury mechanism. RESULTS: Among 5497 trauma patients, the incidence of abuse was 104 (2%) of 4942 children 18 months or older and 175(32%) of 555 children younger than 18 months (odds ratio [OR], 21.4 +/- 2.9, P < .001). There were 1252 (23%) patients with lower extremity injuries in the entire sample, and 66 of these were younger than 18 months. In the extremity trauma group, for patients 18 months or older, 16 (1%) of 1186 were abused compared with 44 (67%) of 66 patients younger than 18 months (OR, 146 +/- 53, P < .001). Among all trauma patients younger than 18 months, 41 of 55 lower extremity fractures were linked to abuse, whereas 134 of 500 other injuries were caused by abuse (OR, 8.0 +/- 2.6, P < .001). Among the 41 abuse-related fractures, femur fracture was the most common (22), followed by tibia fracture (14). CONCLUSIONS: Among children 18 months or older, abuse is an uncommon cause of lower extremity trauma. In children younger than 18 months, lower extremity injuries, particularly fractures, are highly associated with child abuse. Clinicians must thoroughly investigate lower extremity injuries in this age group.