When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Child abuse

Última revisão: 14 Aug 2025
Última atualização: 24 Jul 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • 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
  • family known to social services
  • small bowel perforation in a child <3 years of age
  • torn frenum
Detalhes completos

Outros fatores diagnósticos

  • 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
Detalhes completos

Fatores de risco

  • 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
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • CBC
  • clotting profile/coagulation studies
  • dilated funduscopy
  • photo-documentation of injuries
  • skeletal survey
  • CT brain
  • LFTs/amylase/lipase
  • serum calcium
  • serum phosphate
  • serum alkaline phosphatase
  • serum parathyroid hormone
  • serum 25-hydroxyvitamin D
  • urinalysis
Detalhes completos

Investigações a serem consideradas

  • 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
Detalhes completos

Algoritmo de tratamento

AGUDA

reasonable concern for, or high likelihood of, child abuse

Colaboradores

Autores

Marcella M. Donaruma-Kwoh, MD, FAAP

Associate Professor of Pediatrics

Baylor College of Medicine

Division of Public Health Pediatrics

Texas Children's Hospital

Houston

TX

Declarações

MMD declares that she has worked as an expert witness in the field of Child Abuse Pediatrics and is compensated for hours spent in reviewing cases and providing opinions.

Agradecimentos

Dr Marcella M. Donaruma-Kwoh would like to gratefully acknowledge Dr James L. Lukefahr and Dr Amy R. Gavril, previous contributors to this topic.

Declarações

JLL and ARG declare no competing interests.

Revisores

Naomi Sugar, MD

Clinical Professor

Department of Pediatrics

University of Washington School of Medicine

Seattle

WA

Declarações

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

Jonathan Thackeray, MD

Clinical Associate Professor

Department of Pediatrics

Center for Child and Family Advocacy

Columbus Children's Hospital

Columbus

OH

Declarações

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

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Suniega EA, Krenek L, Stewart G. Child abuse: approach and management. Am Fam Physician. 2022 May 1;105(5):521-8. Resumo

National Institute for Health and Care Excellence. Child abuse and neglect. Oct 2017 [internet publication].Texto completo

Christian CW, Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 2015 May;135(5):e1337-54.Texto completo  Resumo

Centers for Disease Control and Prevention. Child abuse and neglect prevention. Apr 2022 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Diagnósticos diferenciais

    • Coagulopathy
    • Osteogenesis imperfecta (OI) and other bone fragility disorders
    • Glutaric aciduria
    Mais Diagnósticos diferenciais
  • Guidelines

    • Oral and dental aspects of child abuse and neglect: clinical report​
    • Evaluation of suspected child physical abuse
    Mais Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer