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Последний просмотренный: 21 Jan 2026
Last updated: 24 Jul 2025

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • 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
Полная информация

Другие диагностические факторы

  • 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
Полная информация

Факторы риска

  • 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
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • 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
Полная информация

Исследования, проведение которых нужно рассмотреть

  • 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
Полная информация

Алгоритм лечения

Острый

reasonable concern for, or high likelihood of, child abuse

Составители

Авторы

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

Раскрытие информации

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.

Выражение благодарностей

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

Раскрытие информации

JLL and ARG declare no competing interests.

Рецензенты

Naomi Sugar, MD

Clinical Professor

Department of Pediatrics

University of Washington School of Medicine

Seattle

WA

Раскрытие информации

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

Раскрытие информации

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.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

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

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

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.Полный текст  Аннотация

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

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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