A Silent Scream in the Pediatric Emergency Department: Child Abuse and Neglect

Abstract The aim of this study is to determine the demographic and clinical characteristics of patients suspected of child abuse or neglect in the pediatric emergency department and to draw attention to this issue, which poses a great threat to the development of children. Between July 1, 2017 and July 1, 2022, the files of 851 patients who were admitted to the emergency department of a tertiary children's hospital without a trauma center and reported to the medical social services unit with a preliminary diagnosis of neglect and/or abuse were retrospectively scanned through the registry system. The patients' age, gender, time period when they were admitted to the hospital, reason for admission, presence of recurrent admission for different reasons suggestive of maltreatment, physical examination findings, forensic reports, management of the patients, and outcome were recorded. The patients were divided into five groups according to their victimization: physical, sexual and emotional abuse, neglect and Medical Child Abuse (MCA) - Munchausen by Proxy. A total of 371 children who were found to have been subjected to child maltreatment were included in the study. 222 (59.8%) of the patients were female and the median age was 161 months IQR (46–192). 56.3% of the patients were in the adolescent age group. The most common admission time period was between 16.00 and 24.00, 163 (43.9%). 24.2% of the patients were exposed to physical abuse, 8.8% to sexual abuse, 26.1% to emotional abuse, 50.4% to neglect, and 3.2% to MCA. 108 (29.1%) patients were followed up as inpatients in the pediatric intensive care unit. 4 of the patients (1%) had cardiac arrest outside the hospital, and the deaths were in patients under 2 years of age. Conclusion: Pediatric emergency departments are the units most frequently visited by patients suffering from child maltreatment. Victimized children may try to make their silent screams heard through different clinical presentations. Babies are at the greatest risk of suffering serious or fatal injuries. Health professionals working in the emergency department have an important role in detecting, treating and preventing recurrence of child neglect and abuse. Emergency department physicians must be able to hear these screams of patients while struggling with the dense crowd.