A bizzare case of battered child syndrome.

The battered child syndrome or 'child abuse' may be manifested in many ways, including physical and mental injury , nutritional and hygienic neglect, delayed treatment of illnesses, sexual abuse of maltreatment of other forms. We report a rather bizzare form of child abuse, the father being the perpetrator. A 2 1/2-year-old boy was brought to Christian Medical College. Ludiana for management of a tight mid-esophageal stricture resulting from accidential caustic ingestion. A gastrostomy was performed and he was started on a regimen of retrograde esophageal dilatation using Tucker dialators. A no. 1 nylon thread passed via the nose and pulled out from the gastrostomy site was left as a retrieval line. The two ends of the thread were rolled over spools and taped onto the cheek and abdominal wall respectively. After the third esoph-ageal dilatation, the child was brought twice to us within a period of one week with loss of the retrieval line. The first time Ravitch's technique of introducing the orogastric string was used(l). The child was admitted and a spool of nylon thread was suspended above the child's head and the end of the thread was passed into the baby's mouth. As the baby chewed and swallowed, the thread found it's way through the stricture into the stomach from where it could be retrieved with a clamp under general anesthesia, the second time, we could pass a nylon thread attached to an infant feeding tube no. 10 across the stricture rather easily. The same could be fished VOLUME 32-DECEMBER 1995 out through the gastrostomy without any anesthesia. The child had never been accompanied by his parents and the aunt who brought him to the hospital was very reluctant to give an accurate account of the facts. When repeatedly questioned, she confessed that the retrieval line had been pulled out by the father. On further probing she narrated that it was not an accidental ingestion, but the father had knowingly made the child drink the caustic. He was abusing the child as part of his tactics to pressurize his wife to agree to 'divorce by mutual consent', for which she was unwilling. It is on record that orogastric string used as retrieval lines for retrograde di-latation have been inviting harrassment by peer and siblings(2), but a father being a perpetrator has never been reported. An ingenious method of concealing such a string has been described(2). When confronted with …