The battered child syndrome revisited.

Of 419 patients referred for investigation of child abuse at the University of California at Los Angeles during the period between 1977 and 1979, 66 were eventually clinically confirmed as victims of physical child abuse; 106 others were classified as victims of either neglect or sexual molestation. Soft-tissue injuries, characterized by linear clustering over the face, trunk, and buttocks along with a 20% incidence of thermal abuse, were emphasized in the diagnosis and were present in 82% of the children. Over half of the children had soft-tissue injuries alone. In addition, a series of 89 fractures occurring in these children together with a group at Los Angeles Orthopaedic Hospital was analyzed as to frequency, type, and special characteristics. The old adage of "three fractures in different stages of healing" should be downplayed as the primary catch phrase in the diagnosis of child abuse. From the standpoint of the child victim, healing fractures are found very late in the clinical course. Instead, more emphasis should be placed on the specific nature of the fractures, e.g., bilaterality, corner metaphyseal patterns, transepiphyseal injury, and key locations. The concept of a Child Abuse Team was validated by this study in that the recurrent battering rate was reduced from 50% in the recent literature to 9% in this series.