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Battered Baby Syndrome (or Caffey Syndrome)


By Waseem Shehzad (PMC)
waseem_dr@hotmail.com

Battered Baby Syndrome (BBS) is a clinical condition in young children (less than 3 yrs) who get non accidental injuries from their guardians.

6 Patterns of Child Abuse
· Physical 
· Nutritional
· Sexual
· Intentional drugging
· Medical care negligence
· Emotional

Victim
Unwanted or illegitimate child or wth doubted father paternity

Precipitating Factor
A cry which disturbs parent's sleep, Outing, or T.V programme
And battering is due to sudden loss of temper.

Assaliant's Features
· Low IQ level
· History of family discord,chronic emotional problems, financial stress ,
· Criminal background
· Got similar treatement from their own parents

Types of Injuries
1. Common Injuries
· Multiple,may not be severe
· Localized bruises on head,face ,trunk, and extremities
· Tear of upper lip frenulum and alveolar margins of gums

2. Fatal Injuries
· Head Injury-----------Fractured skull, Subdural hematoma
· Visceral Injury ----------- Ruptured liver, Mesenteric hemorrhage

Points to be Considered in BBS
1. When degree and type of injury varies wth history given
2. With injuries of different ages and healing 
3. Purposeful delay for medical care 
4. When above injuries found
5. When sudden death

Autopsy Examination in BBS
External Examination
1. Clothing---------cleanness and repair
2. Weight, height and circumference of head and state of nutrition noted
3. Any record of suspected trauma,wth detail
4. Asymmetry of head or limbs
5. Above injuries
6. Burn,  scars, joint swelling, congenital deformities, fresh cigerrate burns,
7. injuries to eyes
8. Injuries to genitals

Body X-Rays
To know skeletal changes due to BBS or disease there should be photos with child in clothes ,all external injuries ,and  injuries noted during examination.

Internal Examination
There may be
· Bruises
· Brain injuries
· Cerebral oedema
· Bleeding into vitreous ,dislocation of lens, and retina due to direct violence to head

Neck
· There may be obstruction or lesion of respiratory tract.
· Injuries to hyoid , thyroid cartilage or soft tissues

Chest & Abdomen
· FRACTURE OF RIBS, Vertebral bodies 
· Ruptured viscera e.g: Duodenojejenal junction, pancreas and liver.
Both due to blunt objects
· Nobbing fractures
· 
Extremeties
· Aavulsion and chipping of epiphysis at knee and elbow
· Raised periosteum wth Ssubperiosteal calcification
· Asymmetry of arms or legs showing fracture