Battered-Child Syndrome

To many doctors, the incident is becoming distressingly familiar. A child, usually under three, is brought to the office with multiple fractures--often including a fractured skull. The parents express appropriate concern, report that the baby fell out of bed, or tumbled down the stairs, or was injured by a playmate. But X rays and experience lead the doctor to a different conclusion: the child has been beaten by his parents. He is suffering from what last week's A.M.A. Journal calls "the battered-child syndrome."

Psychopathic Personalities. There is no indication that the ancient ritual of child beating has been mitigated by modern theories of child raising. Parents continue to kick and punch their children, twist their arms, beat them with hammers or the buckle end of belts, burn them with cigarettes or electric irons, and scald them with whatever happens to be on the stove. Gathering documentation from 71 hospitals, a University of Colorado team headed by Pediatrician C. Henry Kempe found 302 battered-child cases in a single year; 33 of the children died, 85 suffered permanent brain damage. An accompanying Journal editorial predicts that when statistics on the battered-child syndrome are complete, "It is likely that it will be found to be a more frequent cause of death than such well-recognized and thoroughly studied diseases as leukemia, cystic fibrosis and muscular dystrophy."

Although the Colorado doctors found that "beating of children is not confined to people with a psychopathic personality or of borderline socioeconomic status," as is often thought, the beatings usually indicate psychologically disturbed parents. Occasionally a child beater will admit and even boast of the beatings, but in most cases the parents deny any responsibility for the injury, and voluntarily bring the child for treatment, often to a different doctor after each successive beating. Parental denial of any wrongdoing reinforces a doctor's natural hesitance to consider child beating as the cause of injury. Detection may be further hampered by the child's inability to speak for himself.

Physician's Responsibility. But switching doctors, falsifying medical histories and feigning concern cannot change a child's X rays. Says the Kempe report: "To the informed physician, the bones tell a story the child is too young or too frightened to tell." Since child beating is almost always repeated, X-ray signs of fractures in different stages of healing are almost always a strong indication of parent-inflicted injuries. "The radiologic features are so distinct." say the Colorado doctors, "that other diseases generally are considered only because of the reluctance to accept the implications of the bony lesions [bone injuries]."

The A.M.A. Journal report argues that doctors must overcome this reluctance, must be ready to assume responsibility for the safety of the child. Objective and well-documented evidence should be submitted to legal authorities. "Above all," concludes the report, "the physician's duty and responsibility to the child requires a full evaluation of the problem and the guarantee that the expected repetition of trauma will not be permitted to occur."

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