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Bruise of child abuse - Suspected Child Abuse
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Bruise of child abuse - Suspected Child Abuse

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Contributors: Mary Spencer MD, Noah Craft MD, PhD, Ann Lenane MD, Amy Swerdlin MD, Manasi Kadam Ladrigan MD, Carol Berkowitz MD
Other Resources UpToDate PubMed

Synopsis

Accidental bruising is common in healthy and active children. However, bruises can also be a sign of child abuse and are the most common type of physical injury in abused children. An injury can be considered physical abuse if it is defined as nonaccidental and lasts beyond temporary reddening of the skin. Differentiating inflicted bruises from those sustained accidentally can be challenging. However, a careful evaluation including the distribution, pattern, and history of the skin lesion in the context of the developmental capabilities of the child can help assess whether the injury was intentional.

Physical abuse is the most frequently reported form of child abuse, with skin being the most commonly injured organ system. Abrasions and bruises are the most common signs of child abuse on the skin. Scratches and bites are less common. Burns, hematomas, edema, and marks from physical implements are also less common but should not be missed. Physical abuse can occur in children of any age and has a mean age of 6. Mechanisms of bruising include hitting, whipping, biting, and kicking.

It is important to note that cultural practices such as cupping and coining lead to ecchymosis formation in distinctive patterns. Proper evaluation is necessary because the use of cultural practices does not exclude the potential for child abuse. In these cases, significant attention should also be focused on educating the parents to explain the adverse outcomes, discourage future harmful behavior, and suggest alternative forms of treatment.

Childhood physical abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. It is estimated that each year over 3 million children are victims of abuse, with close to 2,000 fatalities secondary to maltreatment. Although awareness is increasing, it is often challenging to differentiate findings attributable to child abuse from those of other benign skin conditions.

Codes

ICD10CM:
T76.12XA – Child physical abuse, suspected, initial encounter

SNOMEDCT:
371779005 – Physical child abuse

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Differentiating features from abuse include critical elements of the history and physical exam, such as the characteristics of the lesion and associated symptoms.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 12/14/2018
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Bruise of child abuse - Suspected Child Abuse
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Bruise of child abuse : Geometric configuration, Linear configuration, Ecchymosis
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