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Last Updated: 2/12/2014  

Child Physical Abuse (Pediatrics)

Prevention
  • Identify children and families who are at increased risk for physical abuse, and intervene to decrease risk.

  • Children with disabilities and younger children may be at increased risk for child physical abuse.

  • Recognize the risk factors for child physical abuse (see detailed list).

  • Provide parents of newborns with information on the dangers of shaking an infant and on strategies for coping with a crying infant.

Screening
  • Identify injuries in children that are suspicious for abuse and perform a careful evaluation.

  • Multiple retrospective reviews have documented missed opportunities for medical providers to diagnose abuse in young injured patients.

  • Consider performing screening for abuse in both the primary care setting and in the emergency department but recognize that the efficacy has not been established.

Diagnosis
  • Identify any red flags in the history that may suggest child abuse in a child with a physical injury (see detailed list).

  • Carefully document a detailed history in the medical record, including information about the mechanism, timing, and location of the trauma.

  • Conduct a thorough and detailed physical exam to look for signs of physical abuse (see detailed list).

  • In all suspected victims of child physical abuse under age 2 years, obtain a skeletal survey (see list of plain radiograph views).

  • Obtain head CT or MRI, even if neurologically asymptomatic as indicated based on age and risk factors.

  • Consider obtaining laboratory studies in all cases of suspected physical abuse including LFTs, amylase, lipase and urine analysis for erythrocytes.

  • Consider consulting a child abuse pediatrician or child protection team during the evaluation of a child with injuries suggestive of physical abuse.

Therapy
  • Admit any child suspected to be a victim of physical abuse to the hospital if necessary for medical or safety reasons.

  • Use non-drug and drug therapy to treat injuries resulting from child physical abuse in the same manner as injuries sustained by other means.

  • Discuss evaluation of a child suspected to be a victim of physical abuse with caregivers in a nonpunitive and nonjudgmental way.

  • Report any suspected case of child physical abuse to the appropriate local child welfare agency. In all states and the District of Columbia, physicians and nurses are mandated reporters of child abuse.

  • Do not release the child from the hospital until the child is medically ready for discharge and CPS has identified a safe place for the child and has cleared a discharge plan.

DOI: 10.7326/d019
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Joanne N. Wood, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Cindy W. Christian, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Joanne N. Wood, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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