Dating retinal hemorrhages
When the medical evaluation is inconsistent with the history provided by the child's caregiver, physical abuse should be seriously considered.
A complicated and challenging scenario arises when the caregiver accuses an adult from whom the caregiver is divorced or separated as the perpetrator.
A pattern of physical findings, including bruises and fractures in areas unlikely to be accidentally injured, patterned bruises from objects, and circumferential burns or bruises in children not yet mobile, should be viewed as suspicious for child abuse.
Family physicians who suspect physical abuse are mandated to make a report to the state child protective services agency and to assure the ongoing safety of the child.
Unexplained injuries to protected parts of the body such as the buttocks, thighs, torso, frenulum, ears and neck are suggestive of child abuse .
The likelihood of having accidental bruises is a function of a child's behavior and developmental ability.
When possible, separate interviews should be held for the caregiver(s) and the child.