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Emergency: requires immediate attention
General child abuse in Child
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Emergency: requires immediate attention

General child abuse in Child

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

Synopsis

Child abuse is defined as any act or failure to act by a caretaker resulting in serious physical or emotional harm, an imminent risk of serious harm, or the death of a child. It includes sexual abuse and exploitation. It is crucial to recognize abuse early because children have a 50% chance of experiencing recurrent abuse and a 10% chance of death if maltreatment is not detected at the initial presentation. Among children confirmed by Child Protective Services (CPS) agencies as being maltreated, an estimated 61% experienced neglect, 19% were physically abused, 10% were sexually abused, and 5% were emotionally or psychologically abused. Not recognizing signs of abuse and misdiagnosing mimickers of abuse both can lead to devastating consequences for the patient and family involved.

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

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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.

Hematologic:
Dermatologic:
Dermatologic mimics of bruising:
Dermatological mimics of circular or patterned burns:
Other types of burns:
  • 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)
Metabolic/congenital:

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 03/29/2017
Last Updated: 04/26/2019
Copyright © 2019 VisualDx®. All rights reserved.
Emergency: requires immediate attention
General child abuse in Child
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General child abuse
Copyright © 2019 VisualDx®. All rights reserved.