Suspected Physical Child Maltreatment

Bottom line recommendations for the treatment and management of suspected physical child maltreatment - FRENCH. Published online: October 2018.

Bottom line recommendations for the treatment and management of suspected physical child maltreatment. Published online: August 2018.

Bottom line recommendations for the treatment and management of suspected physical child maltreatment - FRENCH. Published online: October 2018.

This guideline covers the signs of possible child maltreatment in children and young people aged under 18 years. It aims to raise awareness and help health professionals who are not child protection specialists to identify the features of physical, sexual and emotional abuse, neglect and fabricated or induced illness.

Childphysicalabuseis an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and preventchild abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physicalabuseof children.

This practice point will help clinicians to distinguish between accidental and inflicted bruises, to evaluate and manage bruising in the context of suspected child maltreatment, and to evaluate for an underlying medical predisposition to bruising.

This clinical report provides guidance to pediatricians and other clinicians regarding the evaluation for bleeding disorders whenchild abuseis suspected.

Initial imaging appropriateness criteria for suspected physical abuse in children.

Fractures are the second most common presentation of physical abuse after skin lesions, and approximately one third of abused children are eventually seen by an orthopaedic surgeon. Thus, an understanding of the differences in the general and musculoskeletal manifestations of accidental and nonaccidental injury is essential for recognition and appropriate management of the abused child.

This overview examined systematic review evidence to answer the questions: can you age bruises accurately in children, and are there patterns of bruising in childhood which are either diagnostic or suggestive of abuse?

Objective: To identify additional studies that contribute to the evidence on distinguishing which fractures are indicative of abuse and optimizing the identification of occult fractures.

This systematic review identifies features of intentional non-scald burns in physical abuse.

Objectives: To define what abusive visceral injuries occur, including their clinical features and the value of screening tests for abdominal injury among abused children.

Aim: To report the retinal signs that distinguish abusive head trauma (AHT) from non-abusive head trauma (nAHT).

Objective: To systematically review the literature to determine which clinical and radiographic characteristics are associated with abusive head trauma (AHT) and nonabusive head trauma (nAHT) in children.

Objective: To identify the evidence base behind the neuroradiological features that differentiate abusive head trauma (AHT) from non-abusive head trauma (nAHT).

Child abuse and neglect (CAN) is a serious problem that has major implications for the welfare of the child involved. Unexplained fractures are of particular concern to the orthopaedic surgeon, who must often consider alternative diagnoses to CAN. We therefore (1) determined which bone diseases most commonly mimic CAN; (2) what types of osteogenesis imperfecta (OI) are most commonly confused with CAN and why; and (3) what specific findings in OI and bone disease render a mistaken diagnosis of CAN more likely.

Aim: Systematic review of 'What are the clinical and radiological characteristics of inflicted spinal injury?'

Screening markers are used in emergency departments (EDs) to identify children who should be assessed for possible physicalabuseand neglect. We conducted three systematic reviews evaluating age, repeat attendance and injury type as markers for physicalabuseor neglect in injured children attending EDs.

Aim: To investigate the optimal neuroradiological investigation strategy to identify inflicted brain injury (iBI).

Aim: A systematic review of the scientific literature to define clinical indicators distinguishing inflicted (iBI) from non-inflicted brain injury (niBI).

Aim: To conduct a systematic review to identify distinguishing features of intentional and unintentional scalds.

A torn labial frenum is widely regarded as pathognomonic of abuse. We systematically reviewed the evidence for this, and to define other intra-oral injuries found in physical abuse.

Aim: To investigate what patterns of bruising are diagnostic or suggestive of child abuse by means of a systematic review.

Aim: To investigate whether it is possible to determine the age of a bruise in a child in clinical practice by means of a systematic review.

Bruising can indicate abuse for infants. Bruise prevalence among infants in the pediatric emergency department (ED) setting is unknown. Our objective is to determine prevalence of bruising, associated chief complaints, and frequency of abuse evaluations in previously healthy infants presenting to pediatric EDs.

Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities.

Our goal was to develop and evaluate a protocol for standardized photography of injuries that may be broadly applied.

This study aims to identify the prevalence and pattern of bruises in preschool children over time, and explore influential variables.

To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population.

Objective: To determine the prevalence of additional injuries or bleeding disorders in a large population of young infants evaluated for abuse because of apparently isolated bruising.

Objective: To describe the characteristics of bruising and mode of presentation of children referred to the paediatric child protection team with suspected physical abuse (PA), and the extent to which these differ between the children where abuse was confirmed and those where it was excluded.

This study was designed to measure the accuracy of a screening instrument for detection of potential child abuse used in EDs.

This review outlines subtle findings of physical abuse in children.

This study aimed to determine the incidence of missed opportunities to diagnose abuse in a cohort of children with healing abusive fractures and to identify patterns present during previous medical visits, which could lead to an earlier diagnosis of abuse.

This review outlines distinguishing characteristics between intentional and unintentional burns.

This review outlines emergency department evaluation of child abuse.

Our objective was to determine how often abused infants have a previous history of "sentinel" injuries, compared with infants who were not abused.

This technical report reviews the major medical conditions that predispose to bruising/bleeding and should be considered when evaluating for abusive injury.

The present article offers practical advice about the approach to: documentation of a child abuse assessment; providing testimony and behaviour in the court system for the nonexpert; and, finally, guidance for individuals giving expert or opinion evidence for medicolegal purposes.

This article describes the evidence base behind the associated historical, clinical and neuroradiological features of abusive head trauma and spinal injury in physical abuse and sets out an algorithm of essential investigations that should be performed in any infant or young child where abusive head trauma is suspected.

We sought to determine whether accidental femur fractures in pediatric patients younger than age 4 could be distinguished from child abuse using a combination of presumed risk factors from the history, physical examination findings, radiographic findings, and age.

Our objective was to conduct a pilot study to identify discriminating bruising characteristics and to model those findings into a decision tool for screening children at high risk forabuse.

The purpose of our study was to describe the patterns of orthopaedic injury for child abuse cases detected in the large urban area that our institution serves, and to compare the injury profiles of these victims of child abuse to that of general (accidental) trauma patients seen in the emergency room and/or hospitalized during the same time period.

This review identifies some of the features that can be used to differentiate abusive fractures from the greater numbers of childhood fractures that are sustained from accidental trauma. Current investigation strategies and diagnostic dilemmas are discussed.

To determine the frequency and location of bruises in normal infants and toddlers, and to determine the relationship of age and developmental stage to bruising.

Objectives: To determine how frequently AHT was previously missed by physicians in a group of abused children with head injuries and to determine factors associated with the unrecognized diagnosis.

Episode 108: In this EM Cases main episode podcast on Pediatric Physical Abuse Recognition and Management Dr. Carmen Coombs and Dr. Alyson Holland discuss the 6 B’s of child abuse, the TEN-4 FACE decision rule, the Pittsburgh Infant Brain Injury Score, disclosure tips, screening tests, reporting responsibilities and more.

Published online: March 2018