Pediatricians who treat children for bruising or bleeding may be concerned that the injury is a result of abuse. Some situations warrant a more complete evaluation to rule out any medical conditions that can be mistaken for abuse. In the April 2013 issue of Pediatrics, the American Academy of Pediatrics (AAP) clinical report, “Evaluation for Bleeding Disorders in Suspected Child Abuse” (published online March 25), provides guidance to pediatricians on evaluating children with bleeding and bruising symptoms that are suspicious for abuse. No single test or panel of tests can rule out every bleeding disorder. The AAP recommends that an evaluation for bleeding disorders is not always necessary in certain situations, such as: abuse that has been witnessed, if a child has made a clear disclosure of abuse, obvious object or hand-patterned bruising, or observed accidental bruising. Because some bleeding disorders can mimic abuse, determining whether a child has been abused based solely on medical findings can be problematic, and requires careful consideration of both abuse and any other medical conditions that may cause symptoms. In certain situations, further testing beyond that recommended in the clinical report may be necessary in collaboration with a pediatric hematologist. A technical report was also published online March 25.
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The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org