Dating retinal hemorrhages
The physician is mandated to report any suspected abuse to the state child protective services agency.
In the face of these new and often unaccustomed roles, hostile families may challenge physicians when the possibility of physical abuse is broached.
Typical features of the history, physical examination and focused laboratory and radiologic studies help physicians in diagnosing physical abuse in children.
In addition, physicians caring for children must remain cognizant of the many medical conditions whose presentation can mimic signs of physical abuse.
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.
In this case, the injury must be evaluated in the context of the history obtained from all those involved and from the physical examination.
The history of a child suspected to be abused should be elicited in a nonaccusatory manner.
While perpetrators of child physical abuse and their victims come from all socioeconomic classes, certain factors place children at increased risk of physical abuse should raise the possibility of a diagnosis of child abuse.6 In many cases, injuries to children who cannot yet talk are not witnessed and may be attributed by the caregiver to another person, either a child or an adult.
However, the patterns of injuries seen in children who are physically abused differ from injuries seen in children who are hurt accidentally.
The physical manifestations of nonaccidental trauma are varied and most commonly involve the skin, bone or central nervous system.
Children are commonly injured accidentally, and a history of age-appropriate injury, not witnessed, should not by itself raise the suspicion of child abuse.
However, injury resulting from inappropriate supervision may raise the issue of neglect, a form of child abuse.
Family physicians who are involved in the care of children are likely to encounter child abuse and should be able to recognize its common presentations.