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

Last reviewed: 3 Nov 2025
Last updated: 24 Jul 2025

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

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
Full details

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
Full details

Diagnostic tests

1st tests to order

  • 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
Full details

Tests 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

ACUTE

reasonable concern for, or high likelihood of, child abuse

Contributors

Authors

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.

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

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
  • Diretrizes

    • Oral and dental aspects of child abuse and neglect: clinical report​
    • Evaluation of suspected child physical abuse
    Mais Diretrizes
  • padlock-lockedConectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal