Child Abuse and Neglect

Table of Contents

1. Child Abuse and Neglect
2. What is Child Abuse and Neglect?
3. Physical Abuse
4. Sexual Abuse
5. Child Neglect
   1. Evaluating a Child for Suspected Nutritional Neglect
   2. Case Study #4
6. When you suspect abuse or neglect
7. Domestic Violence and Children
8. Preventing Child Abuse
9. References

Evaluating a Child for Suspected Nutritional Neglect

A common diagnostic dilemma in general pediatrics is the infant or young child who is not gaining weight appropriately. Each such case will be highly variable in presentation, but the following is a suggested approach for evaluating and treating such a child:

1. An accurate weight, length, and head circumference should be obtained and charted on a standardized growth chart at every well child visit. At a minimum, an accurate weight should also be obtained and charted at every sick visit.

2. Remember that weight gain is usually the first indicator of abnormal growth. If growth in length or head circumference is abnormal, this suggests either an "organic" or intrinsic cause for the growth failure, or else a lengthy period of poor nutrition. In a child who has received regular medical care, these two conditions can usually be readily distinguished. Evaluation of suspected intrinsic causes of growth failure are beyond the scope of this discussion.

3. In the instance where only weight gain is reduced, a careful dietary history often indicates the cause and possible solution. For example, a first-time breastfeeding mother may not realize that it is normal for her infant to nurse every 2 to 3 hours, or the mother of a bottlefed infant may not realize she is supposed to gradually increase the amount of formula in each bottle as the infant grows. Occasionally, older children are noted to be underweight due to intake of large amounts of apple juice or soda to the exclusion of more nutritious foods.

4. The parents should be given suggestions for optimizing the infant's or child's nutritional intake, and a followup appointment should be scheduled for a few days later.

5. At the follow-up visit, if significant weight gain has occurred (20 to 30 grams a day is the usual guideline for the first year of life), then no further workup is usually needed. Two or three subsequent follow-up visits, 2 to 4 weeks apart, are recommended.

6. If inadequate weight gain has occurred by the first follow-up visit, then screening tests for infection or other "organic" or intrinsic problems are usually obtained. Typically, these include a complete blood count, urinalysis, and screening chemistry panel.

7. If no consistent pattern of weight gain has occurred by the second follow-up visit and no intrinsic cause of the poor weight gain has been identified, admission to the hospital and reporting to Child Protective Services should be seriously considered.