A 14-month-old boy brought dead to hospital shows healing rib fractures of varying stages, bilateral retinal haemorrhages, and a thin subdural collection over both hemispheres, with only faint fingertip bruising on the chest. The MOST common cause of death in battered child syndrome is:

• A Aspiration pneumonia
• B Ruptured liver
• C Haemorrhagic shock from limb fractures
• D Head injury ✓

Explanation

Intracranial injury, whether inflicted impact or shaking, is the leading cause of death in physically abused infants, consistent with the retinal haemorrhages and subdural blood described here. Abdominal visceral injury such as ruptured liver or spleen ranks second, and limb fractures rarely bleed enough to cause fatal shock. Aspiration pneumonia may complicate prolonged neglect but is not the classic terminal event. Bruises of differing ages, as in this child, signal repeated episodes of abuse.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.