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
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
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
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
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
Алгоритм лечения
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
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.
Отличия
- Coagulopathy
- Osteogenesis imperfecta (OI) and other bone fragility disorders
- Glutaric aciduria
Больше ОтличияРекомендации
- Oral and dental aspects of child abuse and neglect: clinical report
- Evaluation of suspected child physical abuse
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