Clerkship Ready: Pediatrics

Before You See a Child Who May Have Been Abused

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Child abuse, which is sometimes called non-accidental trauma, is a public health problem with life-long health consequences for survivors and their families. In this episode, we will review what you need to know before you encounter your first patient who may have or has been abused. We will focus on physical and sexual abuse of children. 

  1. Long term health consequences of child abuse
  2. Why identification of child abuse is difficult
    1. It is often difficult to distinguish an accidental injury from a non-accidental injury
    2. A caregiver who has abused a child rarely confesses to harming the child
    3. Child may be brought to medical care by unsuspecting parent
    4. It is emotionally difficult for us to confront parents when there are concerns for abuse
    5. Mandated reporting of child abuse
    6. Potential clues that a child may have been physically abused
      1. Medical record review
      2. History
      3. Physical exam
      4. Differential diagnosis of physical abuse
      5. Labs and other tests that you may get
      6. The role of the child protection team and child protective services
      7. Potential clues that a child may have been sexually abused
        1. History
        2. Physical exam
        3. Lab testing
        4. Medical documentation

          5. Resources/Links:

          1. Christian CW; Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 2015 May;135(5):e1337-54. doi: 10.1542/peds.2015-0356.
          2. Pierce MC, Kaczor K, Lorenz DJ, Bertocci G, Fingarson AK, Makorof K, Berger RP, Bennett B, Magana J, Staley S, Ramaiah V, Fortin K, Currie M, Herman BE, Herr S, Hymel KP, Jenny C, Sheehan K, Zuckerbraun N, Hickey S, Meyers G, Leventhal JM (2021) Validation of a clinical decision rule to predict abuse in young children based on bruising characteristics. JAMA Netw Open 4(4):e215832. https://doi.org/10.1001/jamanetworkopen.2021. 5832. Erratum in: JAMA Netw Open. 2021 Sep 1;4(9):e2130136. PMID: 33852003; PMCID: PMC8047759
          3. Smith T, Chauvin-Kimoff L, Baird B, Ornstein A. The medical evaluation of prepubertal children with suspected sexual abuse. Paediatr Child Health. 2020 Apr;25(3):180-194. doi: 10.1093/pch/pxaa019. Epub 2020 Apr 10. PMID: 32296280; PMCID: PMC7147698
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