Reference no: EM133522395

The child above, returns to the ED two months later (4 months of age) with repeated seizures during the afternoon. The mother describes that the infant fell off the couch at noon. He hit his face and had jerking motions of his arms and legs lasting 15 seconds. The mother states that the episode resolved and he seemed well. He was placed in a crib for a nap. Three hours later she went to his crib and found him having a tonic-clonic seizure of all extremities, which lasted one minute. He appeared lethargic. He vomited once and had three more similar episodes. When the grandmother returned home from work four hours later, they drove him to the ED where he is noted to be lethargic, with the following vital signs: P 120, R30, BP 70/40. Wt 6 kg, Ht 66 cm, HC 42 cm. His exam is remarkable for a full fontanel, a weak cry, and dried blood on his upper gum with a frenulum tear. He has no signs of external head trauma or body bruises. His pupils are equal and reactive to light. The retina are difficult to examine.

When obtaining more history from the mother, she also notes that he still has not had any immunizations. She describes him as being irritable and a difficult baby to console, and a poor feeder. His stools are described as normal.

A CT scan of the brain shows a right subdural hematoma with generalized cerebral edema. He is admitted to the pediatric ICU. Initial labs are normal, but a skeletal survey demonstrates several rib fractures and a right tibia fracture. An ophthalmologist is consulted who determines that there are bilateral retinal hemorrhages.

Discuss cultural and societal differences related to the definition of abuse and neglect.