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Child abuse begins early  according to JAMA report Among children hospitalized for blunt trauma, abused children, on the average, have more severe injuries, require more medical services, have higher mortality rates and have worse functional outcomes than children hospitalized with unintentional injuries, according to an article appearing in a recent issue of Archives of Pediatrics & Adolescent Medicine, a member of The Journal of the American Medical Association (JAMA) family of journals.    Researchers from Tufts University School of Medicine, Boston, and colleagues studied medical records (of injured children, newborn to age four) submitted to the National Pediatric Trauma Registry between Jan. 1, 1988 and Dec. 31, 1997.    During the 10-year study period, the researchers found that child abuse accounted for about 11 percent of all blunt trauma to patients younger than five years.    The children injured by child abuse tended to be younger (the age for abused children averaged about 13 months while children with unintentional injuries had an average age of approximately 26 months) and they were more likely to already have a medical history prior to injury (53 percent vs. 14.1 percent).     Of the abused children, 27.8 percent had retinal hemorrhages while only 0.06 percent of those with unintentional injuries had retinal hemorrhages.      “Abused children were mainly injured by battering (53 percent) and by shaking (10.3 percent); unintentionally injured children were hurt mainly by falls (58.4 percent) and by motor vehicle-related events (37.1 percent),” the researchers write.     Abused children were more likely to have head, chest, and abdominal injuries than their unintentionally injured peers.    They were also more likely to be admitted to the intensive care unit and to receive Child Protective Services and Social Services intervention.