December 11, 2023

Before You See a Child Who May Have Been Abused

35 minutes

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.

Long term health consequences of child abuse

Why identification of child abuse is difficult

It is often difficult to distinguish an accidental injury from a non-accidental injury

A caregiver who has abused a child rarely confesses to harming the child

Child may be brought to medical care by unsuspecting parent

It is emotionally difficult for us to confront parents when there are concerns for abuse

Mandated reporting of child abuse

Potential clues that a child may have been physically abused

Medical record review

History

Physical exam

Differential diagnosis of physical abuse

Labs and other tests that you may get

The role of the child protection team and child protective services

Potential clues that a child may have been sexually abused

History

Physical exam

Lab testing

Medical documentation

Resources/Links:

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.

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

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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