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<< Nonaccidental Injury in Pediatric Patients: Detection, Evaluation, and Treatment (Trauma CME)

Risk Management Pitfalls in the Management of Cases of Suspected Nonaccidental Injury

1. “I thought bruising on the lower extremities could be a normal finding in a 3-month-old infant.”

Bruising is the most common detectable injury in maltreatment; it is missed as a sentinel injury in about one-third of fatal or near-fatal abusive injuries. Though bruising to anterior lower legs in mobile children can commonly occur from accidental injuries, bruising is uncommon in children who are premobile (in general, children aged < 6 months).

2. “I thought I had to wait until I was certain that some form of abuse had occurred before I reported to CPS.”

All medical providers are considered mandated reporters and should report any concern for the possibility of abuse to CPS as soon as suspicion arises. A local child protection specialty physician can also be contacted to discuss concerns. Reporting to CPS facilitates the investigation and the mobilization of resources to help the child, and does not automatically trigger removal of the child from the home.

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