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Potentially life-threatening emergency
Physical child abuse - Suspected Child Abuse
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Physical child abuse - Suspected Child Abuse

Contributors: Mary Spencer MD, Carol Berkowitz MD, Tara Holloran MD, FAAP, Antoinette L. Laskey MD, MPH, MBA, FAAP
Other Resources UpToDate PubMed


Physical child abuse means injury to the child either by acts of commission (abuse, ie, inflicted injury as opposed to an accidental injury) or omission (neglect). Physical abuse can occur in children of any age but has a mean age of 6 years. Per the Administration for Children and Families (US Department of Health and Human Services), a national estimate of 1820 children died from abuse and neglect in 2021 at a rate of 2.46 per 100 000 children in the population. Younger children are the most vulnerable to death as the result of child abuse and neglect. Data show that in 2021, 66.2 percent of child fatalities were younger than 3 years and close to one-half (45.6%) of child fatalities were younger than 1 year.

Abuse can occur by hitting, whipping, biting, kicking, choking, shaking, burning, or any physical means.

Population risk factors that have been identified to increase the potential for abuse may include young parents, children with special health care needs or developmental disorders, substance use or mental health issues in the home, and poverty.*

*Note: Risk factors are population risk factors and should never be relied on to decide who to further evaluate, who to report, when to worry about abuse, etc. Doing so may result in misdiagnosis and delay to diagnosis. The facts of the specific case are far more important than profiling who is at risk.

Related topics: bruise of child abuse, pediatric abusive head trauma, child sexual abuse


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

371779005 – Physical child abuse

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Differential Diagnosis & Pitfalls

  • Hemophilia A
  • Immune thrombocytopenic purpura (ITP)
  • Von Willebrand disease
  • Immunoglobulin A vasculitis (formerly Henoch-Schönlein purpura)
  • Phytophotodermatitis
  • Congenital dermal melanocytosis (formerly Mongolian spot), Nevus of Ito, Nevus of Ota
  • Vascular malformations (see Cutaneous arteriovenous malformation, Venous malformation)
  • Subcutaneous fat necrosis of the newborn
  • Disseminated intravascular coagulation (DIC)
  • Cutaneous mastocytosis (Urticaria pigmentosa, Diffuse cutaneous mastocytosis)
  • Langerhans cell histiocytosis
  • Bullous impetigo
  • Staphylococcal scalded skin syndrome
  • Petechia or purpura from systemic bacterial or viral infection such as Acute meningococcemia
Metabolic / congenital:
  • Osteogenesis imperfecta
  • Ehlers-Danlos syndrome
  • Vitamin D deficiency
In addition:
  • The examining physician should be aware of Cultural practices such as cupping, coining, spooning, moxibustion, and caida de la mollera to be able to differentiate their accompanying signs from physical abuse.
  • Dog-inflicted abrasions – This pattern can be mistaken for inflicted belt marks. With a scratch caused by a dog paw, the red lines are abraded; you should be able to feel the skin disruption. If the dog is large, the abrasions are often surrounded by bruising. In contrast, belt or cord marks are strips of bruising, typically without disruption of the skin surface and usually without a lot of surrounding bruising.

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Last Reviewed:12/13/2022
Last Updated:03/12/2023
Copyright © 2024 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Physical child abuse - Suspected Child Abuse
A medical illustration showing key findings of Physical child abuse : Geometric configuration, Linear configuration, Ecchymosis
Copyright © 2024 VisualDx®. All rights reserved.