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Examining for a Dislocated Hip in Infants

In many countries clinical examination is the primary screening tool to identify dislocated hips in newborns, with a positive screening examination typically triggering an ultrasound assessment of the hips. However, the condition is rare and the examination can be difficult to perform. We explore the key components of the examination - symmetry of limb length, symmetry of abduction and consider the ’special tests’ of instability, known as the ‘Barlow’ and ‘Ortolani’ maneuvre. However, given the rarity of the disease, even in expert hands for every 1000 newborn hips screened with the clinical examination, relying on the Barlow and Ortolani maneuvres will identify 5 dislocations, result in 13 “unnecessary” ultrasound scans and 4 missed diagnoses. For every 1000 newborn hips screened with limited hip abduction, the system would identify 1 dislocation, result in 33 “unnecessary” ultrasound scans and 8 missed diagnoses per 1000 newborn hips.

Keywords 
newborns hips Examination dislocated hip Missed Diagnosis

A Practical Guide To Conducting A Child Sexual Abuse Examination

Author/s: 
Gifford, J.

If you work with children, then you are seeing children who have been sexually abused. Many presentations in a health setting go unrecognised.

It is a field of paediatric practice that has changed rapidly over the last fifteen years. The evidence base is now set out by the RCPCH, giving a much clearer steer on the interpretation of physical signs. There has been a shift from examinations being provided within a child protection rota, to being carried out by specialists in a Sexual Assault Referral Centre (SARC). In many places, this has meant regionalisation of the service, and in some places, provision outside the NHS. There has been a seismic cultural change in recognition of, and response to, sexual abuse in society as a whole.

Alongside this, the internet has created new ways of grooming and exploitation, and linked together those who seek to normalise CSA offending. The challenge to paediatrics (and to safeguarding and criminal justice systems), is to meet the need that these developments have exposed.

Keywords 
child abuse Sexual abuse Examination

A Practical Guide To Conducting A Child Sexual Abuse Examination

Author/s: 
Gifford, J.

If you work with children, then you are seeing children who have been sexually abused. Many presentations in a health setting go unrecognised.

It is a field of paediatric practice that has changed rapidly over the last fifteen years. The evidence base is now set out by the RCPCH, giving a much clearer steer on the interpretation of physical signs. There has been a shift from examinations being provided within a child protection rota, to being carried out by specialists in a Sexual Assault Referral Centre (SARC). In many places, this has meant regionalisation of the service, and in some places, provision outside the NHS. There has been a seismic cultural change in recognition of, and response to, sexual abuse in society as a whole.

Alongside this, the internet has created new ways of grooming and exploitation, and linked together those who seek to normalise CSA offending. The challenge to paediatrics (and to safeguarding and criminal justice systems), is to meet the need that these developments have exposed.

Keywords 
child abuse Sexual abuse Examination
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