Child abuse is common. Although the presentation of a child nearly beaten to death, severely burned, or shaken until comatose leads to vivid, frightening, lifelong memories for emergency physicians, these cases are not common. In one sense, these horribly dramatic cases are easy to manage. The disposition is clear—the nearest pediatric intensive care unit if the child survives the ED course. Cost issues are clear—you ignore them and put all possible resources toward saving the child until futility is obvious. Reporting issues are pretty clear—the police are called. Other issues, such as holding up a bed in the ED awaiting child protective services, family inconvenience, and concerns about hassling an innocent family with “false accusations” are just not important. In a way, we are all fortunate that child abuse is seldom so clear cut.

Child abuse (sometimes also referred to as child maltreatment or nonaccidental or inflicted trauma) is a term applied to a spectrum of adult behavior that is somewhat artificially divided into four categories: physical abuse, sexual abuse (to be covered separately in a future issue of Pediatric Emergency Medicine Practice), emotional abuse, and neglect. Any of these forms of abuse can have profound and disturbing effects on the growth and development of the abused child.

case of “touching me” can be reported, the rape may beEmergency physicians can play a pivotal and vital role in identifying and reporting suspected child abuse. This is one of the few times when an emergency physician can effectively perform preventative medicine. If the prevented. If the case of “suspicious bruises” can be reported, the severe beating may be prevented. If the case of an “odd fracture” can be reported, the brain damage from a severe shaking may be prevented.

This issue of Pediatric Emergency Medicine Practice explores the ED identification and management of child physical abuse. An examination and critical evaluation of the literature has been used to develop a state-of-the art approach to these challenging ED cases.

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