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 particularly 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
Editor’s note: The AAP has
published several other reports that provide guidance on diagnosing abusive
in cases of suspected child abuse.
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American Academy of Pediatrics is an organization of 62,000 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.