It can be hard to diagnose abuse in kids.

RECENT CASES illustrate how rare diseases can be mistaken for child abuse, mimicking the bleeding or fractures of shaken-baby syndrome.

DORNSIFE, Pa. – The pathologist saw blood in the brain and hemorrhaging in one retina of the dead 4-month-old Amish girl. As a result, a coroner ruled the death homicide due to shaken-baby syndrome, stunning the tiny town of Dornsife and Pennsylvania’s scattered Amish communities.

Days later, an expert on Amish illnesses said the ruling was wrong, that Sarah Lynn Glick died of a vitamin K deficiency Vitamin K Deficiency Definition

Vitamin K deficiency exists when chronic failure to eat sufficient amounts of vitamin K results in a tendency for spontaneous bleeding or in prolonged and excessive bleeding with trauma or injury.  and a rare liver disease Liver Disease Definition

Liver disease is a general term for any damage that reduces the functioning of the liver.
Description

The liver is a large, solid organ located in the upper right-hand side of the abdomen. .

Two months later, authorities are trying to unravel the truth.

Whatever the eventual ruling, Sarah’s death is one more example of the sometimes blurred line between illness and child abuse, as when a rare disease mimics the bruising, bleeding or fractures of shaken-baby syndrome.

In 1999, Minnesota officials took 1-year-old Wyatt Hines from his parents for three months after finding fractures in the boy’s bones. His parents insisted he had osteogenesis imperfecta osteogenesis imperfecta

Group of connective-tissue diseases in which the bones are very fragile. Several forms probably reflect different degrees of expression of the same disorder. , or “brittle-bone disease,” a hard-to-diagnose disease the Osteogenesis Imperfecta Foundation says may affect 20,000 to 50,000 people in this country.

In another case, a newborn was taken from her parents in Denver in 1991 before doctors diagnosed her with glutaric aciduria aciduria /ac·id·u·ria/ (as?i-du´re-ah) excess of acid in the urine. For those characterized by increased concentration of a specific acid, see at the acid.  type 1, a liver disorder. In Nashville, an infant with the liver disease Alagille’s syndrome was briefly sent to a foster home in 1993.

Doctors are required by law to report suspicious cases to social workers. “If it’s disease, the worst you have is an angry family. If it’s abuse, the other kids are in deadly danger,” said Dr. Randall Alexander of the Center for Child Abuse at Atlanta’s Morehouse School of Medicine Morehouse School of Medicine is a medical school in Atlanta, Georgia, USA.

Originally part of African-American all-male Morehouse College, it was founded in 1975 during the tenure of college president Hugh M. .

In Sarah’s case, the first to question the pathologist’s conclusion of homicide was Dr. Holmes Morton of the Clinic for Special Children in Strasburg.

“When you see a child that has blood in the brain, you must think child abuse, because unfortunately that happens in our culture; but you must also think of other disorders that mimic it,” Morton said.

Dr. Michael Kenny Michael Vincent Kenny (born June 19, 1964 in Lower Hutt) is a former heavyweight boxer from New Zealand, who won the gold medal in the men’s super heavyweight (+ 91 kg) division at the 1990 Commonwealth Games. , the pathologist at Geisinger Medical Center Geisinger Medical Center is a hospital in Danville, Pennsylvania, serving as the primary hospital for the also Danville-based Geisinger Health System, a primary chain of hospitals and clinics–which includes the Danville medical center– across northeastern and central Pennsylvania.  where Sarah died, is expected to report on his review of the case next week.

Neither Kenny nor Tony Rosini, Northumberland County’s district attorney, returned calls for comment.

“We’re on hold,” said State Police Cpl. Carey Latsha, who oversaw the investigation.

Sarah’s parents, dairy farmers Dairy Farmers is one of Australia’s largest and oldest dairy manufacturers, established in 1900, supplying products to local and international markets such as eastern Europe, the Middle East and Asia.  Liz and Samuel Glick, found her unconscious Dec. 21, after the infant had been vomiting vomiting, ejection of food and other matter from the stomach through the mouth, often preceded by nausea. The process is initiated by stimulation of the vomiting center of the brain by nerve impulses from the gastrointestinal tract or other part of the body.  for days. She died two days later. Declaring it abuse, child services put the Glicks’ other seven children in foster care until Feb. 17.

“Liz is a very quiet, calm person,” neighbor Lisa Williard said. “This really has boggled my mind.”

Morton said that, earlier this century, doctors frequently saw babies with hemorrhaging caused by vitamin K deficiencies. Today, babies get vitamin K vitamin K

Any of several fat-soluble compounds essential for the clotting of blood. A deficiency of vitamin K in the body leads to an increase in clotting time. In 1929 a previously unrecognized fat-soluble substance present in green leafy vegetables was found to be required  in shots and baby formula, but Sarah, delivered by a midwife and breast-fed breast·feed or breast-feed
v. breast-fed , breast-feed·ing, breast-feeds

v.tr.
To feed (a baby) mother’s milk from the breast; suckle.

v.intr.
To breastfeed a baby. , got neither. Without it, her blood did not clot properly.

Compounding Sarah’s problem was a genetic liver defect, Morton said. Even if she had been getting the vitamin, her body would not have been able to break it down.

The illness is not widely known, but Morton still criticized the handling of Sarah’s death. Reports of similar cases involving vitamin K deficiency have appeared in several medical journals.

“The data was in the file the day she died and was never read or understood by the people that pressed this investigation,” Morton said. “We haven’t discovered anything that supports a diagnosis of abuse in this child.”

Authorities who have dealt with similar cases say there is good reason to thoroughly investigate claims of disease that could actually be signs of child abuse.

“You’re going to err on the side of protecting the child,” said Susan Gaertner, a prosecutor in Minnesota. “Would people want us to do it any other way?”

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Diseases that can mimic child abuse

Osteogenesis imperfecta, or brit-tle bone disease: Affects more than 20,000 people. Similar illnesses: hypophosphatasia, juvenile osteoporosis.

Alagille’s syndrome: The liver disease can cause clotting problems and a thin skull that cracks easily. Affects one in 100,000 people.

Byler’s disease: One of three kinds of liver diseases particularly common among Amish.

Glutaric aciduria, or GA-1: It can lead to a dangerous buildup of acid in newborns, causing brain damage and paralysis. Symptoms include retinal bleeding.

Mongolian spots: The birthmarks Birthmarks Definition

Birthmarks, including angiomas and vascular malformations, are benign (noncancerous) skin growths composed of rapidly growing or poorly formed blood vessels or lymph vessels. , in some cases, appear similar to bruising.

Sources: Osteogenesis Imperfecta Foundation; Clinic for Special Children in Strasburg, Pa.; American Academy of Pediatrics The American Academy of Pediatrics (“AAP“) is an organization of pediatricians, physicians trained to deal with the medical care of infants, children, and adolescents. Its motto is: “Dedicated to the Health of All Children. ; National Clearinghouse on Child Abuse and Neglect Information.

Source:

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