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
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
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
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
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
Algoritmo de tratamiento
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
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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Más DiferencialesGuías de práctica clínica
- Oral and dental aspects of child abuse and neglect: clinical report
- Evaluation of suspected child physical abuse
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