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Child Abuse-or Mimic?

A mother presented to the ED with her 3-year-old child asking about an URI and an incidental wound around the child’s neck. She said that the child got tangled in a dog leash.

Case and photo courtesy of Gregory Wallace, DO

Except for the child’s neck injury and the URI symptoms, the physical examination was unremarkable. No addition tests were done at this point.

Because of the delay in seeking care and the appearance of a possible choking injury, the ED staff wanted more information about the injury before discharging the child.

The father was contacted and gave an almost unbelievable account of the accident. The child was alleged to have been walking the neighbor’s dog when he became tangled in the leash. The explanation was inconceivable as first described by the father. Social service was contacted.

What factors about this case worry you most? What would mitigate - or confirm - your fears that this child has been abused?

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