Given location and relative rarity, anogenital injuries in children often prompt concern for maltreatment. We present a case of localized intravascular coagulopathy as a complication of venous malformation, which mimicked abusive trauma leading to an evaluation for maltreatment. Comprehensive assessment identified the underlying medical cause. This case represents an example of the importance of objective assessment in unusual case presentations to ensure diagnostic accuracy, and appropriate direction of medical and child protection resources.
Amidst the opioid crisis, acute pain management in pediatric trauma is complicated by the fact that children respond differently to pain than adults. This is largely due to incomplete development of neural networks and immature mechanisms in verbalizing distress. Much of the literature emphasizes that adequate and timely analgesic relief in pediatric patients is necessary to avoid complications of chronic pain. This article analyzes current strategies in nonpharmacologic and pharmacologic alternatives to opioid management in the setting of pediatric trauma. We also acknowledge that, albeit having a lower incidence than in the adult population, opioid use disorders (OUD) are a serious consequence of narcotic prescriptions in adolescent patients, and emergency and primary care providers must remain vigilant of the signs and symptoms of OUD.
When a child presents to the emergency department with injuries concerning for abuse, a complete evaluation must look beyond the patient's physical exam to identify potential sources of harm as well as protective factors in the family's psychosocial environment. Here we discuss a structured, evidence-based assessment tool designed by our research team for use in its complete form by social workers (when available), or in its abbreviated form by licensed independent practitioners. Even amidst the controlled chaos of the acute care setting, providers can utilize trauma-informed communication strategies to effectively and efficiently elicit an unbiased narrative of relevant historical information and key psychosocial risk factors in the patient's home environment. Without understanding the contributory role of each component to the child's overall risk of abusive injury, it remains difficult to address the root cause of the problem, and the door is thus left open for ongoing harm.
