More than 650,000 children are
abused in the U.S. every year, and more than 1,500 children die from abuse or neglect. Those who survive maltreatment often suffer life-long health problems including
chronic physical and
mental health conditions.
In an updated clinical report, the American Academy of Pediatrics (AAP) offers primary care physicians new guidance on recognizing signs of abusive injuries so they can protect children from further harm. The report, "The Evaluation of Suspected Child Physical Abuse," is published in the May 2015 Pediatrics (published online April 27). It updates a report published in 2007.
The updated report reflects a greater understanding of how adverse childhood experiences, including physical abuse, affect children's brain development and result in physical and behavioral health problems decades later. Also new is a summary of ways
pediatricians can protect children from abuse, including being alert for abusive injuries that are often overlooked.
"Minor injuries in children are incredibly common, and most are not the result of abuse or neglect," said Cindy Christian, MD, FAAP, the lead author of the report and past chair of the AAP Committee on Child Abuse and Neglect. "But sadly we also know how common it is for physicians to miss cases of child physical abuse. When these injuries are not correctly identified, children often return for medical care later with more severe or even fatal injuries."
Previous, "sentinel" injuries are identified in a quarter of abused infants and in one-third of infants with
abusive head trauma, according to research cited in the report. These injuries may be mistakenly attributed to accidental injury, self-inflicted trauma or medical disease, or imaging studies may be misinterpreted. Identifying injuries is particular difficult in infants and toddlers, who are at highest risk of life-threatening and fatal injuries at the hands of their caregivers.
Some injuries to infants and young children may be explained as from an accidental fall. But the report cites research that a fatal fall for an infant or young child from a short distance is exceedingly rare – less than 1 per 1 million children per year.
The report describes situations when abuse may be indicated in a child with
fractures, such as in children with multiple fractures or in infants who are not crawling or walking and with no known medical conditions. It also provides updated recommendations on the diagnosis of abusive head trauma in infants, which can be due to shaking or blunt impact. When abuse is suspected to be the cause of injury, physicians may conduct tests to screen for other injuries or underlying medical causes to rule out abuse.
Editor's note: The AAP has published several other reports that provide guidance on diagnosing
abusive head trauma,
retinal hemorrhage and
fractures in cases of suspected child abuse.