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Factors leading to abuse / neglect

1: paternal grandfather attempted to snatch the child away from maternalgrandmother's friend while sitting at the front site of car through the window

History

Patient and her older brother(faiz amyshar bin mohd fawwaz) was taken by theirmother (Wan anisah binti wan Rohamidun) to the police station to lodge a policereport against the father( ohd fawwaz bin !a"i sulaiman)for domestic #iolence$%pon lea#ing the police station after lodging a police report& wan anisah& her motherand her friendwas cornered by her father in law (!a"i sulaiman bin hmad)$ Patient was layingon the lap of a friend ( hamidah binti !assan ic 1**1*+*,)claimed that there was a struggle between Pn$ !amidah and -n$ ha"i .ulaiman)

through a partially openedwindow in the front seat$ -n$ !a"i .ulaiman attempted to pull the child out throughthe window$Pn !amidah claims that child had hit her head on the window and both forearmswere bruised$ /o other in"uriesPatient started crying inconsolably after that/o open woundsno seizures/o #omittingble to suckle and breast feed as usual after that!owe#er mother claims that child cries out whene#er she touches the both elbows

Physical Examination

Patient acti#e on handling& pinkanterior fontelle normotensi#e0R2 3secs& warm and pink peripheries4ood pulse #olume

Pupils: ,mm reacti#e bilaterallygood sucking rele5oro6s complete

4ood grasp rele507.: 8R/R.: no .0R& no 90R0learP: .oft& not tender/ot distended;owel sounds heardbilateral elbows redness present on the left

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Investigations

/o fracture seen

Action Taken

0hild was e5amined and 5 ray was re#iewed by 8r$ zreeo treat as .oft tissue in"ury of left arm first;andage left forearm0 ortho clinic in 1+3 for a repeat =ray and reassessment

Child At Present In

(a): mother and grandmother's protection

emp (o0): ,>

Posture: ?ying down

.;P (mm!g): @

8;P (mm!g): +3

Pulse rate (min): 1*+

Respiratory rate (min): 3

.pA3(B): @>

ortho clinic re#iew

pb: assaulted by grandfather last week (11C1D)&sb ortho team at -8& treat as soft tissue in"ury of left arm$

progress:mother claimed patient acti#ely mo#ing affected handtolerating orally wellno fe#erno acti#e complaints

le of left %?:no bruises& not swollen& no erythematous changeschild does not cry on mo#ement of elbow "oints$

radial and ulna pulse palpable

5ray of left humerus re#iewed: no fracture seen

Clinical Plan

dw mr yusufdischarge ortho

ADDED!"

#$/$%/#$&'

&()*+)'$

Fai,ah -inti Abdul

.au 0rtho1aedic

House

0icer

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tca prn