Battling Abuse: Child Abuse Awareness and Prevention

April is National Child Abuse Prevention Month. As we learn more about the relationship between adversity in childhood and its negative effects on adult health outcomes, the early identification and intervention for children who are victims of abuse becomes increasingly important.  Although there are over 2 million reports of suspected child maltreatment per year, victims of child abuse continue to pass through physician offices, emergency departments, and hospitals unrecognized.  These same children, often return with more severe injuries.  Physicians and facilities caring for children can play their role in helping to protect victims of child abuse. Abuse should ALWAYS be considered when there is:

• A vague or no explanation given for a significant injury
• An explicit denial of trauma in a child with obvious injury
• A substantive change in an important detail of the explanation
• An explanation inconsistent with the pattern, age or severity of the injury or injuries, or with the child’s physical and/or developmental capabilities
• An unexplained or unexpected notable delay in seeking medical care
• Markedly different explanations from witnesses for the injury or injuries.
• Injuries to multiple organ systems
• Multiple injuries in different stages of healing
• Patterned injuries
• Injuries to non-bony or other unusual locations, such as over the torso, ears, face, neck or upper arms
• When ANY injury is identified in a young, pre-ambulatory infant, including bruises, mouth injuries, and fractures, intracranial or abdominal injuries.

The following recommendations can help those who care for children protect victims of physical abuse:

1. Consider the possibility of trauma in young infants who present with nonspecific symptoms of possible head trauma, including unexplained vomiting, lethargy, irritability, apnea or seizures, and consider head imaging in their evaluation.
2. A skeletal survey for any child under 2 years old with suspicious injuries can identify occult injuries that may exist in abused children and is useful in the evaluation of suspected abuse.
3. Brain imaging may identify injury in abused infants even in those who are not overtly symptomatic.
4. Examining siblings and household contacts of abused children often reveals injuries to those children; those under 2 years benefit from a skeletal survey.
5. Hospitalization of children with suspicious injuries for medical evaluation, treatment and/or protection may be warranted.
6. Thorough documentation in medical records and effective communication with nonmedical investigators in child protection may improve outcomes of investigations and protect vulnerable children.
7. Physicians and nurses who care for children are mandated reporters of suspected abuse, and reports to Child Protective Services are required by law when there is a reasonable suspicion of abuse. Transferring a child’s care to another physician or hospital does not relieve physicians of their reporting responsibilities.

Additional information is available in the American Academy of Pediatrics Committee on Child Abuse and Neglect report published on Pediatrics (bit.ly/1AwRKHw).