Emergency: requires immediate attention
General child abuse
Alerts and Notices
Synopsis
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 years. Mechanisms of physical abuse include hitting, whipping, biting, and kicking.
A combination of individual, familial, and societal factors contribute to the risk of child maltreatment. Characteristics of children associated with an increased risk of abuse include those with teenage parents, developmental disorders, prematurity, and chronic illness. Familial stressors such as mental illness, substance abuse, poverty, community violence, or unemployment also increase the risk of abuse.
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, leading to close to 2000 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.
Nearly 100 000 children are legally confirmed victims of sexual abuse in the United States every year. Of the 3 million cases of child abuse investigated each year, about 20% are reported as sexual abuse. In the majority of children with legal confirmation of sexual abuse, the genital examination of the abused child is normal. In one study, only 4% of all children referred for medical evaluation of sexual abuse had abnormal examinations at the time of evaluation.
An astute clinician who detects the signs of sexual abuse, physical abuse, or neglect in a patient can routinely save lives by intervening.
Codes
ICD10CM:T76.12XA – Child physical abuse, suspected, initial encounter
SNOMEDCT:
418189009 – Child abuse
Look For
Subscription Required
Diagnostic Pearls
Subscription Required
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.Hematologic:
- Hemophilia (factor XIII and IX deficiencies) (coagulation factor deficiency syndrome)
- Idiopathic thrombocytopenic purpura (ITP)
- Von Willebrand disease
- Leukemia
- ASA toxicity
Dermatologic mimics of bruising:
- Congenital dermal melanocytosis (formerly Mongolian spot)
- Capillary hemangiomas (see infantile hemangioma)
- Lymphangiomas
- Ink, dye, or paint stains
- Blue nevi, especially facial
- Eczema
- Angioedema
- Phytophotodermatitis
- Coagulation disorders (factor VIII and IX deficiencies, von Willebrand's disease, ITP, leukemia, and ASA toxicity)
- Hypersensitivity vasculitis (immunoglobulin A vasculitis [formerly Henoch-Schönlein purpura])
- Hypersensitivity reactions (erythema multiforme, erythema marginatum, erythema nodosum)
- Purpura fulminans of meningococcemia
- Incontinentia pigmenti (rare)
- Disseminated intravascular coagulation (DIC)
- Impetigo
- Café au lait spots
- Chilblains
- Osteogenesis imperfecta
- Ehlers-Danlos syndrome
- Bruising caused by cultural practices such as cupping and coining
- Dermatitis herpetiformis
- Impetigo and bullous impetigo
- Phytophotodermatitis
- Fixed drug eruption
- Varicella
- Guttate psoriasis
- Pityriasis lichenoides (PLEVA)
- Insect bites (including millipede dermatitis)
- Contact dermatitis
- Epidermolysis bullosa simplex
- Staphylococcal scalded skin syndrome
- Stevens-Johnson syndrome
- Pyoderma gangrenosum
- Zoster
- Herpes simplex virus (HSV)
- Pemphigus
- Burns caused by cultural practices such as cupping, coining, and moxibustion
- Car seat buckle burns
- Chemical burns from home remedies
- Garlic burn (common home remedy)
- Sunburns
- Enuresis blanket burn
- Congenital insensitivity to pain
- Nonintentional burns (see thermal or electrical burn)
- Osteogenesis imperfecta
- Ehlers-Danlos syndrome
- Rickets
- Epidermolysis bullosa
Best Tests
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
References
Subscription Required
Last Reviewed:03/28/2017
Last Updated:11/13/2022
Last Updated:11/13/2022
Emergency: requires immediate attention
General child abuse