Last reviewed: 23 Nov 2024
Last updated: 25 Jul 2023
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
Disclosures
MMD declares that she has no competing interests.
Acknowledgements
Dr Marcella M. Donaruma-Kwoh would like to gratefully acknowledge Dr James L. Lukefahr and Dr Amy R. Gavril, previous contributors to this topic.
Disclosures
JLL and ARG declare no competing interests.
Peer reviewers
Naomi Sugar, MD
Clinical Professor
Department of Pediatrics
University of Washington School of Medicine
Seattle
WA
Disclosures
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
Disclosures
JT is an author of a reference cited in this topic.
Differentials
- Coagulopathy
- Osteogenesis imperfecta (OI) and other bone fragility disorders
- Glutaric aciduria
More DifferentialsGuidelines
- Evaluation for bleeding disorders in suspected child abuse
- Evaluation of suspected child physical abuse
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