Abstract

Emergency clinicians frequently face diagnostic and management challenges when assessing the “irritable infant” and managing traumatic injuries with vague or inconsistent histories. Determining whether these presentations are consistent with child physical abuse is difficult, and some emergency clinicians believe that their training has not adequately prepared them for the task.¹ The diagnosis of maltreatment can be critical, since child physical abuse is associated with significant morbidity and mortality. A correct diagnosis may also protect a child from further harm. Research has documented that many children who die from maltreatment had been seen by a medical provider prior to their death. Given that abused children are most often taken to the emergency department (ED) for medical care, it is imperative that emergency clinicians be familiar with the signs of maltreatment.^2-4

Questions that must be considered in the diagnosis of child physical abuse include: (1) How and with whom should the history be conducted, and what information should be obtained?; (2) Which laboratory and imaging studies should be ordered for which patients?; and (3) Which clinical and diagnostic study findings are suggestive of child physical abuse? This issue of Pediatric Emergency Medicine Practice answers these questions and provides emergency clinicians with a comprehensive, up-to-date, and empirically based approach for assessing, diagnosing, and managing suspected child physical abuse. Guidelines from the American Academy of Pediatrics (AAP)^5-8,10 and the National Institute for Health and Clinical Excellence⁹ are particularly useful for evaluating possible child maltreatment. These guidelines are summarized in Table 1.

Keywords:

child abuse OR child maltreatment AND evaluation OR diagnosis OR management