Child Abuse and Neglect

Table of Contents

1. Child Abuse and Neglect
2. What is Child Abuse and Neglect?
3. Physical Abuse
   1. Bruises
   2. Case Study #1
   3. Burns
   4. Case Study #2:
   5. Fractures
   6. Case Study #3:
   7. Quickchecks
   8. Abusive Head Trauma in Infants
   9. Evaluating a child for suspected physical abuse
4. Sexual Abuse
5. Child Neglect
6. When you suspect abuse or neglect
7. Domestic Violence and Children
8. Preventing Child Abuse
9. References

Evaluating a child for suspected physical abuse

When a young, pre-verbal or nonverbal child is seen with injuries suspicious for physical abuse, a prudent and thorough evaluation would consist of the following components.

1. Prompt reporting to Child Protective Services and/or the local law enforcement agency is essential, and also required by law.

2. Complete history of the injury or injuries, with careful documentation of who is providing the history, and recording an accurate timeline of the injury beginning at a point in time when the child was known to be uninjured.

3. If the child is able to describe the injury himself or herself, the most qualified professional available should interview the child alone. Remember: the focus of this interview is to obtain the essential medical information necessary to determine the nature and extent of the child's injuries, and to ascertain whether the child may safely be sent back to his or her home. Ask open-ended questions only, such as "How did you get hurt?" and diligently avoid leading questions such as, "Did your dad hurt you?" In most communities, a videotaped forensic interview will later be obtained at a Children's Advocacy Center, and it is important not to confuse the child or 'telegraph' to him or her which answers you think are 'right' or 'wrong.'

4. Complete physical examination, including careful inspection of all body surfaces. Injuries preferably should be documented photographically and via the use of body diagrams.

5. For any child under age 2 in which physical abuse or severe neglect is suspected, (or an older, nonverbal child at high risk for occult injury), a complete skeletal survey should routinely be obtained. The skeletal survey should consist of at least 2 views of each skeletal region, with additional oblique views of the chest. A one- or two-view "babygram" is not acceptable.

6. If the injuries involve extensive bruising or bleeding, the following laboratory tests should be obtained:

1. Complete blood count
2. Coagulation studies (prothrombin time, partial thromboplastin time, fibrinogen level)
3. Possibly other studies, after consultation with local pediatric hematologists, such as platelet function studies or von Willebrand panel.

7. If a head injury is suspected, a CT scan of the head without contrast should be obtained emergently.

8. If internal abdominal injury is suspected, the following laboratory tests should be obtained, in addition to those listed in #4:

1. Liver transaminases (AST, ALT)
2. Serum amylase and lipase

9. If there is a high index of suspicion for internal chest or abdominal injury, CT scan of the chest and abdomen, preferably with contrast, should be obtained emergently.