Adams JA, Harper K, Knudson S, Revilla J. Examination findings in legally confirmed child sexual abuse: it's normal to be normal. Pediatrics. 1994; 94 (3) : 310-7.
Keywords: Child, Child Abuse, Sexual/*diagnosis/legislation & jurisprudence, Colposcopy, Discriminant Analysis, Female, Genitalia, Female/anatomy & histology/*injuries, Humans, Photography, Physical Examination, Reference Values
BACKGROUND: Studies of alleged victims of child sexual abuse vary greatly in …
BACKGROUND: Studies of alleged victims of child sexual abuse vary greatly in the reported frequency of physical findings based on differences in definition of abuse and of "findings." This study was designed to determine the frequency of abnormal findings in a population of children with legal confirmation of sexual abuse, using a standardized classification system for colposcopic photographic findings. METHODS: Case files and colposcopic photographs of 236 children with perpetrator conviction for sexual abuse, were reviewed. The photos were reviewed blindly by a team member other than the examiner, and specific anatomical findings were noted and classified as normal to abnormal on a scale of 1 to 5. Historical and behavioral information, as well as legal outcome was recorded, and all data entered into a dBase III program. Correlations were sought between abnormal findings and other variables. RESULTS: The mean age of the patients was 9.0 years (range 8 months to 17 years, 11 months), with 63% reporting penile-genital contact. Genital examination findings in girls were normal in 28%, nonspecific in 49%, suspicious in 9%, and abnormal in 14% of cases. Abnormal anal findings were found in only 1% of patients. Using discriminant analysis, the two factors which significantly correlated with the presence of abnormal genital findings in girls were the time since the last incident, and a history of blood being reported at the time of the molest. CONCLUSIONS: Abnormal genital findings are not common in sexually abused girls, based on a standardized classification system. More emphasis should be placed on documenting the child's description of the molestation, and educating prosecutors that, for children alleging abuse: "It's normal to be normal."
Brown SD. Ethical challenges in child abuse: what is the harm of a misdiagnosis?. Pediatric Radiology. 2021; 51 (6) : 1070-1075.
Keywords: Child, *Child Abuse/diagnosis, Diagnostic Errors, Expert Testimony, Humans, *Physicians, *Radiology
In this article the author examines ethical tensions inherent to balancing …
In this article the author examines ethical tensions inherent to balancing harms of false-negative and false-positive child abuse diagnoses, and he describes how such tensions manifest in courtroom proceedings. Child abuse physicians, including pediatric radiologists, shoulder heavy responsibilities weighing the potential consequences of not diagnosing child abuse when it could have been diagnosed (false negatives) against the consequences of making the diagnosis when it has not occurred (false positives). These physicians, who practice under ethical obligations to serve children's best interests and protect them from harm, make daily practice decisions knowing that, on balance, abuse is substantially more underdiagnosed than over diagnosed. Legal justice advocates, however, emphasize that clinical decision-making around abuse is not disassociated from endemic injustices that unduly incriminate individuals from socioeconomically underprivileged populations. Some defense advocates charge that child abuse physicians are insufficiently sensitive to harms of erroneous diagnoses, and they have characterized these clinicians as frankly biased. To support their claims in court, defense advocates have enlisted likeminded physician witnesses whose credentials as experts flout professional standards and who provide consistently flawed testimony based upon deficiently peer-reviewed literature. This article concludes that, to help mitigate these unhealthy circumstances, child abuse physicians might build trust with criminal defense advocates by instituting measures to alleviate perceptions of biases and by more explicitly acknowledging the potential harms of erroneous diagnoses. Professional societies representing these physicians, such as the Society for Pediatric Radiology, could take concurrent measures to help better prepare their constituent clinicians for expert testimony and make them more available to testify.
Csorba R, Atas Elfrink Z, Tsikouras P. Diagnosis of Child Sexual Abuse. Journal of Clinical Medicine. 2024; 13 (23).
Child sexual abuse (CSA) is a widespread and alarming issue, with an estimated …
Child sexual abuse (CSA) is a widespread and alarming issue, with an estimated global prevalence of 12-13% (affecting 18% of girls and 8% of boys). Despite its prevalence, many physicians working with children have insufficient knowledge of the medical diagnosis of CSA. This lack of expertise, combined with the sensitive and complex nature of these cases, often hampers proper identification and management. Diagnosing CSA is particularly challenging and requires specialized skills. A majority of children assessed for suspected sexual abuse present with normal genital and anal findings, which complicates the diagnostic process. Barriers such as professional isolation, societal taboos, and the sensitive nature of the subject often result in diagnostic failures. Accurate medical history taking, diagnosis, and documentation of findings are essential for ensuring a precise diagnosis, safeguarding children, and supporting legal proceedings. However, achieving these goals remains elusive without standardized guidelines and adequately trained healthcare professionals. Training of professionals in observing and reporting child sexual abuse is badly needed. This review explores the current state of medical diagnosis in suspected cases of CSA. This article is based on a selective review of pertinent literature retrieved from various databases, including PubMed and the overall index of the Quarterly Update.
Fisher-Owens SA, Lukefahr JL, Tate AR. Oral and Dental Aspects of Child Abuse and Neglect. Pediatrics. 2017; 140 (2).
Keywords: Adolescent, Bites and Stings/complications/diagnosis, Bullying, Child, Child Abuse/*diagnosis/legislation & jurisprudence, Child Abuse, Sexual/*diagnosis/legislation & jurisprudence, Child, Preschool, Diagnosis, Differential, Female, Guideline Adherence,
In all 50 states, health care providers (including dentists) are mandated to …
In all 50 states, health care providers (including dentists) are mandated to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this report is to review the oral and dental aspects of physical and sexual abuse and dental neglect in children and the role of pediatric care providers and dental providers in evaluating such conditions. This report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect. Oral health issues can also be associated with bullying and are commonly seen in human trafficking victims. Some medical providers may receive less education pertaining to oral health and dental injury and disease and may not detect the mouth and gum findings that are related to abuse or neglect as readily as they detect those involving other areas of the body. Therefore, pediatric care providers and dental providers are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions in children.
Focardi M, Gori V, Romanelli M, Santori F, Bianchi I, Rensi R, Defraia B, Grifoni R, Gualco B, Nanni L, Losi S. 'Mimics' of Injuries from Child Abuse: Case Series and Review of the Literature. Children (Basel, Switzerland). 2024; 11 (9).
The phenomenon of child abuse/maltreatment is underestimated and often …
The phenomenon of child abuse/maltreatment is underestimated and often represents a difficult challenge for healthcare professionals and forensic pathologists who must proceed with the differential diagnosis with accidental or self-induced events, or with lesions due to pathologies that overlap with that of mistreatment, defined as "Mimics". This study presents a case series with the aim of discussing lesions that may mimic signs of physical abuse in children but are due to a different etiology to raise awareness and train healthcare professionals and forensic pathologists on possible confounding factors in order to avoid diagnostic errors. Six cases of "Mimics" out of 418 cases of suspected mistreatment (1.43% of cases) were identified, presenting skin lesions initially classified as injuries of abuse due to their location and type and, in particular, sexual abuse for three cases. Then, the lesions and the subjects, in particular the anamnestic history, were examined by a multidisciplinary team and the diagnosis of genital lichen sclerosus et atrophicus in three cases, and the results of popular healing techniques (i.e., "cupping") in the other three cases were ascertained. These situations require specific skills and a forensic background from healthcare professionals to conduct a correct differential diagnosis and the intervention of a multidisciplinary team to investigate every possible pathology or alternative therapeutic practice that could simulate child abuse. In particular, when "mimics" are due to alternative medicine, it should not strictly be considered child abuse, but professionals must be aware of the hypothesis of mistreatment in case of non-medical indication or potential personal injuries from other crimes, such as illegal practice of the medicine. This awareness is also crucial to direct the child toward appropriate medical care, and it is essential to recognize that these conditions can coexist within the same clinical presentation.
Frasier, LF. Child abuse or mimic: Vaginal bleeding in an infant. Cliggot Publications. Consultant for Pediatricians. 2003; 2 (1) : 30-33.
Frasier KM, Fritts HA, Li V, Dudzik C, Sobotka M, Click K, Loperfito A. Advancing Understanding of Dermatological Manifestations in Munchausen Syndrome by Proxy. Cureus. 2024; 16 (10) : e71616.
This comprehensive review critically examines the complex relationship between …
This comprehensive review critically examines the complex relationship between Munchausen Syndrome by Proxy (MSBP) and its dermatological manifestations, uncovering new insights into the relatively uncharted territory of this psychiatric disorder. By synthesizing existing literature, case studies, and clinical observations, this paper reveals the multifaceted spectrum of dermatological phenomena seen in individuals affected by MSBP, ranging from self-inflicted injuries to entirely fabricated skin conditions. Additionally, we explore the psychological and behavioral mechanisms driving caregivers to induce or stimulate dermatological symptoms, shedding light on underlying psychopathologies, the nuanced dynamics of the caregiver-patient relationship, and patterns of pathological attachment and dependency. This review confronts the significant obstacles healthcare providers encounter in accurately identifying dermatological symptoms related to MSBP amidst genuine dermatologic conditions, underscoring the indispensable role of a multidisciplinary strategy and heightened clinical vigilance in these complex cases. Future investigations call for the development of standardized assessment tools, the potential of biomarkers for early detection, the exploration of the neurobiological basis of MSBP, and the utilization of specific interventions to protect susceptible populations while improving the accuracy of MSBP diagnoses. This paper calls for a more informed, sensitive, and proactive approach to better understanding and treating the dermatological manifestations of MSBP.
Myers JEB, Berliner L, Briere C, Hendrix CT, Jenny C, Reid TA, American Professional Society on the Abuse of Children. APSAC Handbook on Child Maltreatment, Second Edition. Thousand Oaks (CA): Sage Publications. 2002.
Hauschild MH, Omar HN, Bauer M, Sarkisova N, Lee CJ, Wren TAL, Goldstein RY. Investigating the Determinants of Nonaccidental Trauma Evaluation in Pediatric Femur Fractures. The Journal of the American Academy of Orthopaedic Surgeons. 2024; 32 (19) : 915-920.
Keywords: Humans, Retrospective Studies, Infant, *Child Abuse/diagnosis/statistics & numerical data, *Femoral Fractures/diagnosis/etiology, Male, Female, Child, Preschool, Infant, Newborn, Practice Guidelines as Topic
BACKGROUND: Femoral fractures in children have the highest probability for …
BACKGROUND: Femoral fractures in children have the highest probability for abuse after skull fractures and humeral shaft fractures. However, the reported proportion of pediatric femur fractures that result from nonaccidental trauma (NAT) varies in the literature from 2% to 60%. The purpose of this study was to determine the patient characteristics associated with a physician's decision to conduct a NAT workup and challenge universal clinical practice guidelines stating that all children younger than 3 years with a diaphyseal femur fracture be evaluated for NAT. METHODS: A retrospective review was conducted on patients aged 0 to 36 months diagnosed with a femur fracture between January 1, 2004, and April 9, 2019, at our institution. NAT was defined as a diagnosis of trauma that was nonaccidental in the medical chart after a positive workup by skeletal survey, ophthalmological examination, or other appropriate referral made by the institution's child abuse and neglect team. Patients with incomplete medical records were excluded. RESULTS: A total of 299 patients were identified, and 22 were excluded. 71% (197/277) were screened for NAT. Patients younger than 1 year were significantly more likely to undergo a NAT workup ( P = 0.009; Odds Ratio [OR], 2.3; 95% CI, 1.2 to 4.4) and receive a positive result from the NAT workup ( P < 0.0005; OR, 11.3; 95% CI, 4.6 to 27.4). Additional injuries were also a significant predictor of a positive NAT workup ( P < 0.001; OR, 5.3; 95% CI, 2.4 to 11.9). Patient race/ethnicity, sex, and fracture type were not markedly associated with the physician's decision to conduct a NAT workup. CONCLUSIONS: Infants younger than 1 year with a femur fracture and children younger than 3 years presenting with a femur fracture and another injury are at increased risk of possible NAT. While clinical practice guidelines may minimize racial bias in NAT evaluation, this study demonstrates that universal NAT workups for walking-age children in the absence of other evidence of abuse may be unnecessary. LEVEL OF EVIDENCE: This is a Level III retrospective cohort study.
Hornor G. Medical Child Abuse: Essentials for Pediatric Health Care Providers. Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 2021; 35 (6) : 644-650.
Keywords: Child, *Child Abuse/diagnosis/psychology, Humans, Pediatric Nurse Practitioners, Physical Examination
Medical child abuse (MCA) is a rare but potentially deadly variant of child …
Medical child abuse (MCA) is a rare but potentially deadly variant of child maltreatment. MCA results in unnecessary health care for a child because of a caregiver's exaggeration, fabrication, or induction of physical and/or psychological symptoms of illness. These unnecessary health care interventions result in a morbidity rate of 100% in the form of complications and disabilities and a mortality rate as high as 9%. Although MCA is relatively rare, it is estimated that pediatric health care professionals, including pediatric nurse practitioners, will most likely encounter at least one MCA victim in the course of their career. This continuing education article will discuss MCA in terms of definition and features, epidemiology, perpetrators, variants in presentation, consequences, and implications for practice.
Kellogg ND, Farst KJ, Adams JA. Interpretation of medical findings in suspected child sexual abuse: An update for 2023. Child Abuse & Neglect. 2023; 145 : 106283.
Keywords: Humans, Child, *Child Abuse, Sexual/diagnosis, Sexual Behavior, Consensus, Health Personnel
Health care professionals who examine children who may have been sexually …
Health care professionals who examine children who may have been sexually abused need to be able to recognize, and photo-document any physical signs, and to have access to expert reviewers, particularly when signs concerning for sexual abuse are found. Although the general consensus among practitioners is that children will show few signs of sexual abuse on examination, there is considerable variability and rates of positive exam findings among practitioners of different professions, practice settings, and countries. This review will summarize new data and recommendations regarding the interpretation of medical findings and sexually transmitted infections (STIs); assessment and management of pediatric patients presenting with suspected sexual abuse or assault; and testing and treating patients for STIs. Updates to a table listing an approach to the interpretation of medical findings are presented, and reasons for changes are discussed.
Kimberlin DW, Banerjee R, Barnett ED, Lynfield R, Sawyer MH.
Red Book: 2024–2027 Report of the Committee on Infectious Diseases. American Academy of Pediatrics. 2024; Chapter: Sexual Assault and Abuse in Children and Adolescents/Young Adults DOI: 10.1542/9781610027373-S2_005_003.
ISBN: 978-1-61002-737-3
For more than 85 years, health care professionals have “referred to the Red …
For more than 85 years, health care professionals have “referred to the Red Book” for trustworthy guidance on pediatric infectious disease prevention, management, and control. The new 33rd edition continues this tradition of distinction with the latest clinical guidance on the manifestations, etiology, epidemiology, diagnosis, and treatment of more than 200 childhood infectious diseases.
Kroese L, Port C, Hauda W 2nd. Improving the evaluation of non-accidental trauma across multiple specialties at a single institution. Bmj Open Quality. 2025; 14 (1).
Keywords: Humans, Infant, *Quality Improvement, *Child Abuse/statistics & numerical data/diagnosis, Child, Preschool, Child, Infant, Newborn, *Wounds and Injuries, Male, Female, Adolescent, Guideline Adherence/statistics & numerical data/standards
BACKGROUND: Based on the presenting injury, patients undergoing abuse …
BACKGROUND: Based on the presenting injury, patients undergoing abuse evaluation may be managed by different specialties. Our local child abuse specialist expressed concern over the variability in evaluation of patients presenting with injuries concerning for non-accidental trauma (NAT). The aim of this quality improvement project was to increase the percentage of patients for whom there is a concern for NAT who receive a guideline-adherent evaluation from 7.7% to 50% in 6 months' time. METHODS: A committee of physician stakeholders developed criteria for a complete NAT evaluation which were integrated into an order panel with built-in clinical guidance for test selection within our electronic medical record. Data on the completeness of NAT evaluation in paediatric patients 0-18 years of age were collected before and after the order panel release and analysed by admitting service, injury category and equity factors. RESULTS: This initiative increased the percentage of patients with a guideline-adherent evaluation from a mean of 7.7% to 25% within 6 months' time. The number of days between patients with complete evaluations decreased from 63 days to 35 days. Order panel utilisation increased to 55%, and the percentage of evaluation opportunities was more complete when the order panel was used (79% vs 92%). CONCLUSIONS: Standardisation of NAT evaluations through creation of an order panel with a clinical decision tool resulted in more guideline-adherent evaluations. The potential reduction of bias in such evaluations remains an area of interest.
Moore Y, Hopkinshaw B, Arrowsmith B, White C, Gabriel L. Genital bleeding in prepubertal girls: a systematic review. Archives of Disease in Childhood. 2025; 110 (5) : 358-362.
Keywords: Humans, Female, Child, *Child Abuse, Sexual/diagnosis, *Hemorrhage/etiology, Child, Preschool, *Genital Diseases, Female/etiology/diagnosis
INTRODUCTION: This systematic review aims to collate evidence of the causes of …
INTRODUCTION: This systematic review aims to collate evidence of the causes of genital bleeding, other than child sexual abuse and accidental injuries, presenting in prepubertal girls. It provides an update to the 2015 Royal College of Paediatrics and Child Health publication 'The Physical Signs of Child Sexual Abuse', an evidence-based review also known as the Purple Book. METHODS: MEDLINE, EMBASE and Scopus databases were searched for studies published between March 2014 and June 2023. Eligible studies were primary studies reporting on genital bleeding with extractable data for prepubertal girls. RESULTS: 99 studies, describing a total of 672 prepubertal girls, met the inclusion criteria. The most common medical conditions with genital bleeding as a presenting feature were lichen sclerosus, infections and infestations, hormonal causes, urethral prolapse, vaginal foreign bodies and tumours. Meta-analysis was not possible due to the large heterogeneity of the studies. CONCLUSION: This review added further evidence to the 2015 edition of the Purple Book, describing the multiple medical conditions that may present with genital bleeding. Several of these conditions can mimic the presentation of child sexual abuse or may coexist with child sexual abuse.
Narang SK, Fingarson A, Lukefahr J, COUNCIL ON CHILD ABUSE AND NEGLECT, Sirotnak AP, Flaherty EG, Gavril AR, Hoffert Gilmartin AB, et al. Abusive Head Trauma in Infants and Children. Pediatrics. 2020; 145 (4).
Keywords: Biomechanical Phenomena, Child, Child Abuse/*diagnosis/prevention & control, Child, Preschool, Contusions/diagnosis/etiology, Craniocerebral Trauma/*diagnosis/etiology/prevention & control, Diagnosis, Differential, Humans, Infant, Mandatory Reporting,
Abusive head trauma (AHT) remains a significant cause of morbidity and …
Abusive head trauma (AHT) remains a significant cause of morbidity and mortality in the pediatric population, especially in young infants. In the past decade, advancements in research have refined medical understanding of the epidemiological, clinical, biomechanical, and pathologic factors comprising the diagnosis, thereby enhancing clinical detection of a challenging diagnostic entity. Failure to recognize AHT and respond appropriately at any step in the process, from medical diagnosis to child protection and legal decision-making, can place children at risk. The American Academy of Pediatrics revises the 2009 policy statement on AHT to incorporate the growing body of knowledge on the topic. Although this statement incorporates some of that growing body of knowledge, it is not a comprehensive exposition of the science. This statement aims to provide pediatric practitioners with general guidance on a complex subject. The Academy recommends that pediatric practitioners remain vigilant for the signs and symptoms of AHT, conduct thorough medical evaluations, consult with pediatric medical subspecialists when necessary, and embrace the challenges and need for strong advocacy on the subject.
Pierce MC, Kaczor K, Lorenz DJ, Bertocci G, Fingarson AK, Makoroff 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. Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA Network Open. 2021; 4 (4) : 1-12.
Importance: Bruising caused by physical abuse is the most common antecedent …
Importance: Bruising caused by physical abuse is the most common antecedent injury to be overlooked or misdiagnosed as nonabusive before an abuse-related fatality or near-fatality in a young child. Bruising occurs from both nonabuse and abuse, but differences identified by a clinical decision rule may allow improved and earlier recognition of the abused child. Objective: To refine and validate a previously derived bruising clinical decision rule (BCDR), the TEN-4 (bruising to torso, ear, or neck or any bruising on an infant <4.99 months of age), for identifying children at risk of having been physically abused. Design, Setting, and Participants: This prospective cross-sectional study was conducted from December 1, 2011, to March 31, 2016, at emergency departments of 5 urban children's hospitals. Children younger than 4 years with bruising were identified through deliberate examination. Statistical analysis was completed in June 2020. Exposures: Bruising characteristics in 34 discrete body regions, patterned bruising, cumulative bruise counts, and patient's age. The BCDR was refined and validated based on these variables using binary recursive partitioning analysis. Main Outcomes and Measures: Injury from abusive vs nonabusive trauma was determined by the consensus judgment of a multidisciplinary expert panel. Results: A total of 21123 children were consecutively screened for bruising, and 2161 patients (mean [SD] age, 2.1 [1.1] years; 1296 [60%] male; 1785 [83%] White; 1484 [69%] non-Hispanic/Latino) were enrolled. The expert panel achieved consensus on 2123 patients (98%), classifying 410 (19%) as abuse and 1713 (79%) as nonabuse. A classification tree was fit to refine the rule and validated via bootstrap resampling. The resulting BCDR was 95.6% (95% CI, 93.0%-97.3%) sensitive and 87.1% (95% CI, 85.4%-88.6%) specific for distinguishing abuse from nonabusive trauma based on body region bruised (torso, ear, neck, frenulum, angle of jaw, cheeks [fleshy], eyelids, and subconjunctivae), bruising anywhere on an infant 4.99 months and younger, or patterned bruising (TEN-4-FACESp). Conclusions and Relevance: In this study, an affirmative finding for any of the 3 BCDR TEN-4-FACESp components in children younger than 4 years indicated a potential risk for abuse; these results warrant further evaluation. Clinical application of this tool has the potential to improve recognition of abuse in young children with bruising.
Reece RM. What the literature tells us about rib fractures in infancy. National Conference on SBS. SBS Quarterly. 2002; (Fall) : 2-3,6.
American Academy of Pediatrics Council on Child Abuse and Neglect - healthychildren.org
Stirling J, & Gavril A.
Last updated 8/7/2024. Downloaded May 26, 2025.
Child Abuse and Neglect: AAP Policy Explained
Suniega EA, Krenek L, Stewart G. Child Abuse: Approach and Management. American Family Physician. 2022; 105 (5) : 521-528.
Keywords: Adult, *Adverse Childhood Experiences, Child, *Child Abuse/diagnosis/prevention & control/psychology, Emotions, Female, Gender Identity, Humans, Male, Mass Screening, Surveys and Questionnaires
Child maltreatment is a devastating type of adverse childhood experience that …
Child maltreatment is a devastating type of adverse childhood experience that encompasses neglect and emotional, physical, and sexual abuse (including sex trafficking). Adverse childhood experiences are exposures to maltreatment or household dysfunction during crucial developmental periods that disrupt neurodevelopment and can result in lifelong physical and psychological harm, altering the child's behavior and disease risk into adulthood. Maltreatment can affect patients of any gender identity and from all racial and ethnic backgrounds, socioeconomic statuses, and community settings. Use of the validated five-item Pediatric Hurt-Insult-Threaten-Scream-Sex screening tool to identify victims of child abuse is recommended. All suspected cases of child abuse must be reported to Child Protective Services. A trauma-informed approach to care requires that team members be mindful of the potential for traumatic stress, recognize and appropriately respond to the symptoms and signs of trauma, and prevent retraumatization. Prevention through education and anticipatory guidance provided during routine well-child visits and community partnerships can foster awareness and resiliency in children. Although caring for victims of child maltreatment may be among the most challenging professional situations encountered by physicians, advocating for these endangered patients can save lives and help prevent revictimization and chronic sequelae associated with adverse childhood experiences.
Tate AR, Fisher-Owens SA, Spiller L, Muhlbauer J, Lukefahr JL. Oral and Dental Aspects of Child Abuse and Neglect: Clinical Report. Pediatrics. 2024; 154 (3).
Keywords: Humans, *Child Abuse/diagnosis/prevention & control, Child, Mandatory Reporting, Tooth Injuries/diagnosis/therapy/etiology, Oral Health, Physician's Role, Bites, Human/diagnosis, Mouth Diseases/diagnosis/etiology, Child, Preschool
In all 50 states, the District of Columbia, and the Commonwealth of Puerto Rico, …
In all 50 states, the District of Columbia, and the Commonwealth of Puerto Rico, pediatricians, dental professionals, and other physicians are mandated to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this clinical report is to review the oral aspects of abuse and dental neglect in children and the role of pediatricians, dental professionals, and other physicians in evaluating such conditions. This clinical report addresses recommendations on the evaluation of bite marks, as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect. Some physicians may have received less education pertaining to oral health, dental injury, and oral disease. These physicians may not detect the mouth and gum findings possibly related to abuse or neglect as readily as abuse injuries involving other areas of the body. Therefore, pediatricians, dental professionals, and other physicians are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions in children.
Teeuw AH, Kraan RBJ, van Rijn RR, Bossuyt PMM, Heymans HSA. Screening for child abuse using a checklist and physical examinations in the emergency department led to the detection of more cases. Acta Paediatrica (Oslo, Norway : 1992). 2019; 108 (2) : 300-313.
Keywords: Adolescent, *Checklist, Child, Child Abuse/*diagnosis/statistics & numerical data, Child, Preschool, Emergency Service, Hospital/statistics & numerical data, Female, Humans, Infant, Male, *Mass Screening, Physical Examination
AIM: We studied the accuracy of a screening checklist (SPUTOVAMO), complete …
AIM: We studied the accuracy of a screening checklist (SPUTOVAMO), complete physical examination (top-to-toe inspection, TTI) and their combination in detecting child abuse in the emergency department (ED). METHODS: Consecutive patients admitted to the ED of the Academic Medical Center in Amsterdam between January 2011 and 1 July 2013 were included. An Expert Panel assigned a consensus diagnosis to positive cases. For all other and missed cases, the Child Abuse Counselling and Reporting Centre diagnosis was used. RESULTS: We included 17 229 admissions of 12 198 patients. In 46%, SPUTOVAMO was performed, in 33% TTI; 421 children (4.3%) tested positive on either or both, with 68 positive consensus diagnoses. In eight children not reported to the Expert Panel, the Child Abuse Counselling and Reporting Center diagnosis was positive. Ten of 3519 (0.3%) children testing negative on both were child abuse cases; 0.88% of the study group had a final child abuse diagnosis. The estimated PPV was 0.46 for SPUTOVAMO, 0.44 for TTI and 0.43 for the combination. CONCLUSION: Combining screening tests significantly increased the number of test positives and led to more child abuse cases detected. Combined screening for child abuse in all children less than 18 years old presenting to an ED is recommended.
Zeidan NA, Bukhamseen FM, Al-Qassab AT, Alsadah FZ, Menezes RG. Cutaneous mimickers of physical child abuse: A brief overview. The Medico-Legal Journal. 2023; 91 (1) : 26-29.
Keywords: Humans, Child, Female, Male, Diagnosis, Differential, *Child Abuse/diagnosis, Skin/injuries, *Burns/diagnosis, *Physicians
Child abuse is one of the medico-legal issues a physician may face during his/he …
Child abuse is one of the medico-legal issues a physician may face during his/her clinical practice. It has devastating effects on both the child and family, especially psychological. If falsely identified as a child abuse case, it could result in detrimental consequences. Therefore, physicians must recognise and be able to rule out child abuse mimickers, which are often conditions that are mistakenly confused with true physical child abuse. Injuries like bruises and burns are common presentations and therefore it is important to consider cutaneous abuse mimics to avoid incorrect diagnosis of child abuse. This review article sheds light on the most common cutaneous conditions that can mimic physical child abuse, where patients present with patterns of various skin lesions that raise a suspicion of child abuse.
