Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • inconsistent/changing history
  • unexplained/inconsistent injuries in isolation or in combination
  • bruising
  • subdural hemorrhages in an infant/young toddler
  • long bone fractures in a premobile child
  • multiple fractures of different ages and bilateral fractures
  • rib fractures in the absence of major trauma or pathologic causes
  • immersion scalds
  • small bowel perforation in a child <3 years of age
  • torn frenum
  • family known to social services

Other diagnostic factors

  • poor parent-child bonding
  • faltering growth
  • dental neglect
  • petechiae with bruising
  • extensive, multilayered retinal hemorrhages extending to periphery
  • apnea
  • cigarette burns
  • frequent accidental poisonings
  • contact burns
  • dental injuries
  • caustic burns

Risk factors

  • domestic violence
  • substance abuse/mental health disorder in parent/caregiver
  • excessive crying and/or frequent tantrums in infancy
  • lack of maturity/poor coping skills in parent/caregiver
  • parent/caregiver abused as a child
  • poor socioeconomic status
  • demanding parenting role

Diagnostic investigations

1st investigations to order

  • CBC
  • clotting profile/coagulation studies
  • dilated funduscopy
  • photo-documentation of injuries
  • skeletal survey
  • CT brain
  • LFTs/amylase
  • serum calcium
  • serum phosphate
  • serum alk phos
  • serum parathyroid hormone
  • serum 25-hydroxyvitamin D
Full details

Investigations to consider

  • radionuclide bone scan
  • MRI brain/spine
  • ultrasound abdomen
  • CT abdomen
  • platelet function studies and von Willebrand factor assays
  • x-ray mouth
  • forensic dental referral
  • forensic swabs for DNA
  • toxicology testing
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Commander

Medical Corps

United States Navy

Director, Education and Training

Armed Forces Center for Child Protection

Walter Reed National Military Medical Center

Bethesda

MD

Disclosures

ARG declares that she has no competing interests. The view(s) expressed herein are those of the author and do not reflect the official policy or position of Walter Reed National Military Medical Center, the US Navy Bureau of Medicine, the US Navy Office of the Surgeon General, the Department of the Navy, Department of Defense, or the US Government.

Dr Amy R. Gavril would like to gratefully acknowledge Dr James L. Lukefahr, a previous contributor to this monograph, and the assistance of Dr Alison Kemp, Dr Sabine Maguire, and Kim Rolfe (Research Officer). JLL and KR each declare that they have no competing interests. AK and SM are the authors of a number of references cited in this monograph.

Peer reviewers VIEW ALL

Clinical Professor

Department of Pediatrics

University of Washington School of Medicine

Seattle

WA

Disclosures

NS is an author of a number of references cited in this monograph.

Clinical Associate Professor

Department of Pediatrics

Center for Child and Family Advocacy

Columbus Children's Hospital

Columbus

OH

Disclosures

JT is an author of a reference cited in this monograph.

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