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Cultural practices - Suspected Child Abuse
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Cultural practices - Suspected Child Abuse

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Contributors: Mary Spencer MD, Noah Craft MD, PhD, Ann Lenane MD, Amy Swerdlin MD, Manasi Kadam Ladrigan MD, Carol Berkowitz MD
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Synopsis

Many cultures use folk health remedies to treat various illnesses. Some common cultural methods used include cupping, coining, spooning, moxibustion, caida de mollera, and salting. These widely practiced alternative forms of medicine create marks on the skin, such as petechiae, purpura, and hyperpigmentation, that often mimic physical abuse.

Cupping has been used in Middle Eastern, Asian, Latin American, and Eastern European cultures as a form of therapy to treat ailments including pain, poor appetite, fever, and congestion. In the US, this technique is practiced primarily by Russian immigrants. In dry cupping, a heated cup is applied to the skin, creating a suction force from the cooling and contracting air. This is typically applied to the back and thought to "draw out" the ailment. Circular burns from the heat and central bruising and petechiae from the suction effect can be mistaken for abuse. Wet cupping involves the same type of practice, but applied to previously abraded skin.

Coining, also called coin rubbing or cao gio, is practiced by many Vietnamese Americans to treat minor ailments such as fever, headache, and chills. In this ancient Vietnamese folk remedy, the edge of a coin is used to rub oiled skin. This technique is usually applied to the back and results in linear erythematous patches, petechiae, or purpura. Although most of the complications have been minor burns, there have been a few reported cases of serious complications from coining, requiring skin grafts when the heated oil on the skin caught fire. Quat sha, also known as spooning, is similar to coining and used in China to rid the body of illness. This procedure results in a linear pattern of ecchymosis when a porcelain spoon is used to rub wet skin.

Moxibustion involves burning rolled pieces of moxa herb (mugwort or Artemisia vulgaris) over the skin above acupuncture points and allowing it to burn until the onset of pain. It is used in Asian cultures for a variety of symptoms, including fever and abdominal pain. The lesions of moxibustion appear as a pattern of discrete, circular, target-like burns that may be confused with cigarette burns from child abuse.

Caida de mollera refers to the presence of a sunken anterior fontanelle in an infant that is believed in some Mexican American subcultures to cause a variety of symptoms including poor feeding, irritability, and diarrhea. Attempts to correct this condition may involve oral suction over the fontanelle by a folk healer, slapping of the soles of the feet, or shaking of the infant upside down. The shaking is usually nonviolent and generally thought not to cause significant resultant injury. Caida de mollera is an improbable cause of shaken baby syndrome.

Salting is an old Turkish custom thought to improve the health of a newborn's skin. It involves the application of salt to the skin. Rare cases of epidermolysis, severe hypernatremia, and even death have been reported in a few infants that had been intermittently salted since birth.

Understanding cultural practices, which populations typically employ unique remedies, and how to gather an appropriate cultural history can help avoid misdiagnosis and prevent further trauma.

Codes

ICD10CM:
T76.12XA – Child physical abuse, suspected, initial encounter

SNOMEDCT:
371779005 – Physical child abuse

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Last Updated: 02/11/2015
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Cultural practices - Suspected Child Abuse
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Cultural practices : Back, Linear configuration, Ecchymosis, Hyperpigmented patches, Round shape
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