Silverman syndrome is characterized by multiple skeletal lesions, visible on X-rays, in children who are victims of repeated violence. Faced with such a picture, emergency child protection measures must be taken.
Definition: what is battered child syndrome or Silverman syndrome?
According to the latest figures available, 1 child victim of abuse dies every 5 days in France. They are 50,000 to suffer mistreatment (psychological physical, neglect and sexual abuse). Silverman syndrome is characterized by multiple, neglected fractures occurring at different ages, in a child victim of abuse. It was described by the American radiologist and pediatrician Frederic Silverman in the 1950s. “These fractures of different ages are visible on x-rays of a child’s skeleton. Some are already consolidated, others are more recent, others in the process of being consolidated. This is an argument to think that a child is the victim of abuse“, explains Emilie Eyssartier, pediatric surgeon at the Jules Verne clinic, in Nantes. “By extension, Silverman’s syndrome today also affects anything that can be seen on imaging, other than x-rays, such as ultrasound (organ fractures) and/or brain scan (brain damage)”, adds the specialist. Before making a definitive diagnosis of Silverman syndrome, one must first rule out brittle bone disease, a genetic condition characterized by bone fragility. “A disease that is extremely rare but needs to be ruled oute”, notes the pediatric surgeon.
What are the signs of battered child syndrome?
“We make a x-ray of a child’s skeleton when there is a suspicion of abuse. For example, a 3-month-old child who has fallen off the changing table, this alerts caregivers to emergencies because a baby of this age is not yet able to turn over on his own. Other case, a broken femur or tibia in a child who is not yet walking“, illustrates the specialist. If the child suffers from a fracture which seems suspicious to the healthcare team, which the responsible adult is not able to explain, then additional examinations can be carried out in search of a possible Silverman syndrome.”If abuse is suspected, an X-ray of the whole body skeleton is systematically prescribed. You can also ask for a fundus, which allows you to see any brain damage, a hematoma inside the skull. A brain scan may also be done“, adds Emilie Eyssartier.
What are the causes ?
Silverman syndrome is caused by repeated physical abuse, assault and battery, and neglect fractures and injuries caused by these violent behaviors. THE shaken baby syndrome and Silverman syndrome are two distinct syndromes:In shaken baby syndrome, the characteristic intracranial hematoma of a shaken baby is sought. Indeed, when it is shaken, the brain of the small child hits against his cranium, which causes an intracranial hematoma. If this is the only sign of abuse, the diagnosis will not be Silverman syndrome.“, specifies our interlocutor.
What are the consequences of Silverman syndrome?
Silverman syndrome implies that the child has suffered episodes of violence on several occasions. Abuse leaves physical and psychological scars and can be devastating throughout the victim’s life.
What are the features of Silverman syndrome on X-ray?
On x-ray, the body of a child with Silverman syndrome shows signs of fractures on his skeleton, fractures of the limbs, ribs and/or face, in particular of the nose. “These scars are called bone calluses. We find the fracture for which the child was brought to the emergency room and one or more others, at different ages. This means that the child has experienced several episodes of the same type in a few weeks, a few months, which is significant of Silverman syndrome“, explains the specialist.
Silverman syndrome, shaken baby syndrome or other signs of violence… as soon as health professionals suspect a case of abuse in a child, they the legal and ethical obligation to protect it. “They must then report this situation to the public prosecutor and the unit for collecting, evaluating and processing worrying information (CRIP) of their department“, notes the High Authority of Health (HAS). It specifies that it is not necessary to provide proof, it is up to the competent authorities to conduct an investigation after a report.
Thanks to Dr. Emilie Eyssartier, pediatric surgeon at the Jules Verne clinic in Nantes, for her expertise.