Physical Child Abuse
Information has been excerpted from VisualDx clinical decision support system as a public health service. Additional information, including symptoms, diagnostic pearls, differential diagnosis, best tests, and management pearls, is available in VisualDx.
Injuries inconsistent with history or developmental age of the child, scars, hyperpigmentation, and bruises.
Check for oral mucosal trauma, such as torn frenula (both upper and lower labial frenula and lingular frenula), in infants and young children.
Check for subconjunctival hemorrhages in nonmobile infants outside of the neonatal period.
Consider bruises that are inconsistent with the developmental age of the child or that are on multiple body surfaces, or, most importantly, fit the TEN-4 FACESp criteria (for children younger than 4 years of age who have bruising present at the time of the examination):
- TEN-FACES – Body region bruised (torso, ear, neck [TEN]; frenulum, angle of jaw, cheeks [fleshy], eyelids, and subconjunctivae [FACES])
- 4 – Bruising anywhere on an infant 4.99 months and younger
- p – Patterned bruising
There is often a delay in seeking medical care, and there may be temporal or factual inconsistencies in the patient’s history, for example, injuries described may be incompatible with presentation.
Bruises: Look for geometric patterns such as from belt buckles, loops from electric cords, the imprint of the hand, ropes, or linear marks from sticks or rods. Bruises or physical marks can occur anywhere, though the buttocks, arms, head, and neck are the most common locations.
- Cigarette burns are characteristically small and round and may present with scars or new lesions; however, caution is advised in making this diagnosis unless the burn is fresh and/or disclosure criteria are met, as there are many mimics of cigarette burns.
- Immersion injuries are typically symmetric and have sharp lines or drops from splashes.
Head injuries: The child may appear lethargic or irritable, or have vomiting without diarrhea or fever, macrocephaly, or frank neurologic signs such as seizures.
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