Broekhuijsen-van Henten Dorien M, Bosschaart Ad N, Nijs Huub G T
Universitair Medisch Centrum Utrecht, locatie Wilhelmina Kinderziekenhuis, afd. Algemene Pediatrie, Utrecht, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:B378.
Haematomas were observed in three male infants under 1 year of age. In the first case, no suspicion regarding child abuse was raised, but, in retrospect, the appearance of haematomas coincided with the times he had been with a childminder. When he was admitted to hospital for a different reason, namely a serious airway infection, the causal relationship could no longer be established. In the second case, the grandparents told the general practitioner about their suspicion of maltreatment. CT revealed inflicted traumatic brain injury. In the third case, inflicted traumatic brain injury was also observed, in addition to a corner fracture of the tibia. Child abuse is a widespread problem that is not always recognized by physicians. Haematomas in infants should be evaluated carefully with thorough investigations for bleeding disorders on one hand and the possibility of child abuse on the other. A careful history concerning the circumstances of injury is essential, keeping in mind the age and development of the child. Localization and patterns of haematomas should also be evaluated. Haematomas in children who do not crawl or walk should lead to suspicion of child abuse. In the case of child abuse, direct action should be taken to ensure the safety of the child.
在3名1岁以下男婴中观察到血肿。在第一例中，未引发对虐待儿童的怀疑，但事后回想，血肿出现的时间与他由一名保育员照料的时间相符。当他因另一个原因，即严重的气道感染住院时，已无法确定因果关系。在第二例中，祖父母向全科医生讲述了他们对虐待行为的怀疑。CT显示存在外伤性脑损伤。在第三例中，除了胫骨角骨折外，还观察到外伤性脑损伤。虐待儿童是一个普遍存在的问题，医生并非总能识别出来。对于婴儿的血肿，一方面应通过全面检查出血性疾病、另一方面应排查虐待儿童的可能性来进行仔细评估。了解受伤情况的详细病史至关重要，同时要考虑到儿童的年龄和发育情况。还应对血肿的位置和形态进行评估。不会爬行或行走的儿童出现血肿应引发对虐待儿童的怀疑。对于虐待儿童的情况，应立即采取行动确保儿童安全。
