Last reviewed:December 2019
Last updated:April  2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • age <3 years
  • altered mental status: irritability/lethargy/coma
  • clinical findings inconsistent with carer history
  • retinal/vitreal haemorrhages or retinoschisis

Other diagnostic factors

  • no known history of trauma
  • apnoea
  • seizure
  • vomiting
  • loss of muscle tone
  • brisk or asymmetrical reflexes
  • unexplained bruising
  • increasing head circumference
  • bulging fontanelle
  • long-bone fractures
  • mucosal injury or torn labial/lingual frena
  • anogenital signs and symptoms

Risk factors

  • age <1 year
  • peak of normal crying curve
  • male carer
  • unrelated adult household member
  • male sex
  • socio-economic stressors

Diagnostic investigations

Treatment algorithm

Contributors

Consultant in PICU

Senior Research Fellow

Birmingham Children’s Hospital

Birmingham

UK

Disclosures

BS receives grant funding from the UK NIHR Clinician Scientist Fellowship programme.

Dr Barney Scholefield would like to gratefully acknowledge Dr Joe Brierley, Dr Gavin Wooldridge, and Dr Alice Newton, previous contributors to this monograph. JB, GW, and AN declare that they have no competing interests.

Peer reviewersVIEW ALL

Attending Physician

Child Protection Team

Hasboro Children's Hospital

Assistant Professor of Pediatrics

Alpert Medical School

Brown University

Providence

RI

Disclosures

AG declares that she has no competing interests.

Division Chief

Child Protection Program

UMass Memorial Medical Center

Worcester

MA

Disclosures

RM declares that she has no competing interests.

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