A crying shame: Battered baby

Dear Editor,

Battered baby is a victim of deliberate nonaccidental physical trauma that has been inflicted by a person responsible for the care of the baby.[1] There is a complex interaction of psychopathological, social, and legal aspects.[2] The index case reported here is a 12-month-old female infant who was brought with complaints of persistent inconsolable crying and decreased oral acceptance. On examination, she was irritable and afebrile, with stable vital parameters. There were no external signs of injury. Systemic examination was within normal limits. A meticulous history taken from the parents raised the suspicion of foreign body ingestion, and hence, chest and abdomen radiographs were requested. Surprisingly, the abdominal X-ray revealed two sharp pointed radioopaque objects akin to all pins [Figure 1a]. Thereafter, the infant underwent radiograph of the neck which also revealed five ball pins similar to the other ones [Figure 1b]. The X-rays were shown to the parents, as it was difficult to explain the presence of so many pins at different places in the body. The parents were also surprised but simultaneously anxious and apprehensive. They were unable to answer the questions related to the pins. Repeated history taking revealed dubious and conflicting statements from the parents regarding the onset of the infant's illness. When it was told to them that it could be a medicolegal case, then only they admitted that they have committed it purposefully. Based on these findings, age of the infant and conflicting history given by the parents, “battered baby syndrome” was diagnosed and child social service was alerted. The all pins were surgically removed from pharynx and the bowel. The infant was discharged after 1 week of hospital stay, after counselling of parents and support from social service team.

Figure 1.

(a) Antero-posterior radiograph of the abdomen showing two all pins, one in the duodenum (arrow) and another in the distal jejunum (block arrow), confirmed intraoperativety (b) Anteroposterior radiograph of the neck showing multiple similar all pins (arrows) in the pharyngeal region and parapharyngeal soft tissues

In India, every two out of three children are victims of physical, emotional, or sexual abuse.[3] Out of these, every 89% of the crimes are perpetrated by family members. The world's highest number of working children is in India. While evaluating a case of child abuse or battered baby syndrome, the age of the child, the overall injury pattern, the stated mechanism of injury, and pertinent psychosocial factors must all be considered. Following risk factors have been described in literature as the risk factors for child abuse − lack of family and social support, domestic violence at home, history of abuse in the primary caregiver, parental substance abuse, having a young mother, being a twin, excessive crying by the child, age under 18 months, and hyperactivity.[4] Studies show that systematic screening in emergency departments is effective in increasing the detection of suspected child abuse, which can be reinforced by a legal requirement as well as staff training. Accurate diagnosis and timely intervention are important, because children returned to abusive homes without intervention face a 50% chance of repeated abuse and a 10% chance of death.[4] Early identification of abusive situations has an impressive impact on outcome, because appropriate intervention is effective in reducing the recurrence rate to less than 10%.