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ABBREVIATIONS. RSV, respiratory syncytial virus; LRI, lower respiratory tract infection; RSVIG, respiratorY syncytial virus immune globulin; pfu, plaque-forming units; ICU, intensive care unit; PIV3, parainfluenza virus. Respiratory syncytial virus (RSV) [...]

ABBREVIATIONS. RSV, respiratory syncytial virus; IVIG, intravenous immune globulin; LRI, lower respiratory tract infection; RSVIG, respiratory syncytial virus immune globulin; BPD, bronchopulmonary dysplasia; Ig, immunoglobulin; MPHBL, Massachusetts Public Health Biological [...]

Objective. Differentiating between child sexual abuse and nonintentional causes of anogenital injury can be challenging, and a misdiagnosis can have a profound impact on the child and family. This case series documents an important nonintentional mechanism of anogenital injury that mimics the physical findings of child sexual abuse. Methods. Four children were examined after being run over by a slow-moving motor vehicle. In each case, the wheel of the vehicle passed longitudinally over the child's torso. Results. Two children had perianal lacerations, and 2 had hymenal lacerations. One child with hymen injuries was followed for 4 weeks and developed findings identical to those seen in healed sexual abuse. Conclusions. Children run over by motor vehicles should be evaluated for anogenital injury. If such injury is suspected, it should be fully delineated and documented with colposcopy and follow-up examination. Although the possibility of sexual abuse must be considered, awareness of the occurrence of anogenital injuries in children run over by motor vehicles may prevent the misdiagnosis of acute sexual abuse in children. Conversely, children presenting for evaluation of acute or past sexual abuse should be questioned as to whether they were ever run over by a motor vehicle. Pediatrics 2003;112:e77-e84. URL: http://www.pediatrics.org/cgi/ content/full/112/1/e77; child sexual abuse, motor vehicle injury, genital injury, anal injury.

Shaken-baby syndrome (SBS) has been hypothesized to occur after shaking by an adult during the first 2 years of life. We wondered whether it is possible to achieve rotational forces sufficient to cause SBS-like injuries in children >2 years of age. The present study describes cases of child abuse in older children who presented with the classic ophthalmologic and intracranial findings of SBS. In this case series, 4 cases of older children (2.5-7 years old; 11.8-22 kg) who died from abusive head injuries and who had diffuse retinal hemorrhages identified antemortem were selected for review. The cases were abstracted from hospital charts, records from autopsies, coroners' and district attorneys' offices, and court transcripts. In all 4 cases the history provided by the primary caregiver did not match the severity of the injuries. Three case subjects presented with patterned bruises. Multilayered retinal hemorrhages and acute subdural hematoma were observed in all 4 cases. At autopsy, diffuse axonal injury was evident in 3 of the 4 cases; all 4 cases had optic nerve sheath hemorrhages. None of the victims had skeletal fractures on radiologic examination or at autopsy. This case series demonstrates that it is possible to observe SBS-like retinal and central nervous system findings in the older and heavier child. Our findings underscore the need for providers to consider intentional shaking as a mechanism of injury in the evaluation of abusive head injury in older children. KEY WORDS. shaken-baby syndrome, child abuse, retinal hemorrhages.