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Child abuse

Última revisión: 17 Aug 2025
Última actualización: 24 Jul 2025

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • 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
Todos los datos

Otros factores de diagnóstico

  • 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
Todos los datos

Factores de riesgo

  • 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
Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • 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
Todos los datos

Pruebas diagnósticas que deben considerarse

  • 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
Todos los datos

Algoritmo de tratamiento

Agudo

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

Divulgaciones

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.

Agradecimientos

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

Divulgaciones

JLL and ARG declare no competing interests.

Revisores por pares

Naomi Sugar, MD

Clinical Professor

Department of Pediatrics

University of Washington School of Medicine

Seattle

WA

Divulgaciones

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

Divulgaciones

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.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

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

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  Resumen

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

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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  • Guías de práctica clínica

    • Oral and dental aspects of child abuse and neglect: clinical report​
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