Helping doctors prevent and detect child abuse: 'No bruise in an infant is normal'

The Masonic Children's Hospital in Minneapolis has received a $2.5 million grant to detect and prevent child abuse, with a new program to help doctors and nurses in the difficult task of differentiating accidental injuries from abuse.

The grant from the St. Paul-based Otto Bremer Trust, announced Monday, will support training for the hospital's staff, medical residents and other hospitals. It will also launch a new "No Hit Zone" policy that prohibits any type of physical discipline at the hospital.

"Child maltreatment is a critical issue in pediatric medicine, one we don't talk about enough," said Dr. Joseph Neglia, physician-in-chief of the University of Minnesota-affiliated hospital.

Medical professionals filed 10.8 percent of the 20,167 abuse or neglect allegations that the Minnesota child protection system investigated in 2014. That is the highest number of annual reports since at least 1993 — the earliest year for which figures were available on the Department of Human Services website. Some 6,623 of those reports involved ­physical abuse.

But despite being frequent and legally mandated reporters, few doctors in Minnesota have specialized training to identify which types of injuries indicate maltreatment in a young patient.

Studies have found patterns of child injuries that predict abuse. While it isn't surprising to see bruises on active and accident-prone preschoolers, any bruises on infants are suspicious, said Dr. Nancy Harper, medical director for the Otto Bremer Center for Safe & Healthy Children Center at the hospital. The center is operated by Masonic Children's and Hennepin County Medical Center.

"No bruise in an infant is considered normal to me," Harper said.

Bruising to the ears, neck, hands, chest, buttocks and right arm are predictive of child abuse. The right arm is a tell, Harper explained, because most adults are righthanded, and abusers would likely grab at children's right arms.

In a training session before Monday's announcement, Harper showed medical professionals the signature marks commonly left by open hands, fists, belts, flip-flops and other objects.

Oral injuries in infants and toddlers also are frequently associated with blows to the head, she told the group. "It's a red flag that we cannot afford to miss."

In addition to training hospital staff and new pediatricians, the grant will support teleconferencing that rural hospitals can use to seek advice and opinions from abuse experts at Masonic ­Children's. The hospital also will be able to employ an additional child abuse pediatrician.

Hospitals and clinics themselves can be stressful places, where parents might act out physically against children who misbehave.

The Bremer funding will support No Hit Zone signs in the hospital as well as "distraction packets" that can be given to parents to preoccupy kids who are acting out.

At Monday's training, hospital social worker Rebecca Foell asked colleagues to consider how they would respond to high-risk scenarios, such as a parent yelling at a squirming child in a waiting room or losing patience as a frightened child resists a vaccination.

"Recognize those signs and intervene at that point," she said. "You don't need to wait for something bad to happen."

Jeremy Olson • 612-673-7744