Diagnosis
The diagnosis of child abuse is based on the child's history, physical findings, and when appropriate, laboratory and evidentiary tests. This diagnosis is often complicated and depends on factors in addition to the medical evaluation. Formulating a conclusion and reaching a diagnosis of child abuse may require the assistance of a pediatric child abuse expert.
The suspicion of abuse is not the same as the diagnosis of abuse. Your suspicion, based on sufficient evidence, leads to a report to the State Central Register. This report results in further investigation by Child Protective Services and law enforcement. You should be ready to render opinions regarding the significance, if any, of the medical findings and the likelihood the injury was inflicted. Although the burden of proof of who perpetrated the abuse lies with the investigators, the determination of the cause or possible causes of the injury is often critical to the legal case.
Child abuse may present with suspicious physical findings, a disclosure from a child, a report of a witness, suspicious behaviors in a child, abuse of a sibling or close contact, or some combination of risk factors. Other chapters, such as the chapter on Triage and the chapter on Reporting, offer guidance in the recognition of signs and symptoms of child abuse. This chapter is intended to supplement this guidance with a focus on diagnosis based on evaluation of some common specific findings. It is not a comprehensive review of all forms or types of diagnoses of child abuse.
Key Concepts
- Sexual Abuse
- The Normal Examination
- Interpretation of Genital Findings
- Genital Bleeding
- Spermatozoa
- Sexually Transmitted Infections
- Physical Abuse
- Findings Suggestive of Physical Abuse
- Culture-Based Practices that May Be Interpreted as Abuse
- Female Circumcision or Female Genital Mutilation
- Bruises
- Neglect
- Emotional and Psychological Abuse
- References and Resources
