Non-Accidental Trauma

* Estimated 10% of pediatric patients are victims of abuse* Sexual abuse* Physical abuse* Neglect* Common red flags* Changing story* Story that doesn’t make since* Delays in seeking care* Unusual bruising locations* Torso* Ears* Neck* Common tests if non-accidental trauma suspected* Skeletal survey x-rays* Head CT* Especially if altered mental status* Abdominal CT* Especially if abdominal trauma* Report to child protective services (CPS)

Tummy Ache

* Necrotizing enterocolitis* Classic presentation* Premature baby* 1st month of life* Ill appearing* Classic finding on x-ray* “Pneumatosis intestinalis”* Volvulus* Classic presentation* 1st month of life but previously healthy* Distended abdomen* Bilious vomiting* Testing* Abdominal Xray* Upper GI Series (ideal test)* Toxic megacolon* Complication of Hirchsprung Disease* Seen on x-ray* Intussusception* Telescoping bowel resulting in ischemia* Classic presentation* 2 months – 2 years old* Intermittent abdominal pain followed by lethargy* Diagnose with abdominal ultrasound* Pyloric stenosis* Classic presentation* Projectile vomiting* Normal appetite/hungry* Palpable “olive” in epigastrium * Testing* Electrolyte panel* Hypokalemia* Hypochloremia* Alkalosis* Abdominal ultraound

Additional Reading

* Pediatric Abdominal Pain (EM Clerkship)