Identification and management of child abuse and neglect

• Published in: BMJ (Online) 2024-11, Vol.387, p.e079054
• Main Authors: Schwartz, Sarah B, Schonfeld, Deborah, Pederson, Payton, Yeung, Frances
• Format: Article
• Language: English
• Subjects: Abdomen; Apnea; Body measurements; Caregivers; Child abuse & neglect; Child welfare; Children; Contusions; Decision making; Developmental stages; Diarrhea; Drug abuse; Emergency medical care; Emotional abuse; Emotions; Families & family life; Health care; Hemorrhage; Infants; Injuries; Pediatrics; Physical training; Practice; Risk factors; Sex crimes; Sexual abuse; Skin; Social services; Socioeconomic factors; Trauma
• ISSN: 1756-1833; 1756-1833
• DOI: 10.1136/bmj-2023-079054

Correspondence to: F Yeung [e-mail] What you need to know Child maltreatment may present with subtle features, and a history of abuse or neglect is not typically provided Perform a full skin and intraoral examination in pre-mobile infants, consider occult injury screening, and use age- and situation-appropriate questions to help identify maltreatment If child sexual abuse is suspected, limit the number of physical assessments to minimise trauma to the child and contact the local sexual assault (referral) centre in a timely manner Given the potential for legal proceedings, ensure documentation is clear and objective, using quotations, drawings, and photographs when indicated Child abuse and neglect, collectively known as maltreatment, is common, and most healthcare providers who care for children will encounter some form of maltreatment in their practice.1 Common presentations include physical abuse, sexual abuse and commercial sexual exploitation of children, and neglect. Child maltreatment is the physical, sexual, and psychological/emotional abuse, and neglect of infants, children, and young people aged 0-17 years by parents, caregivers, and other authority figures, as defined by the World Health Organization (box 1).6 Emotional abuse and fabricated or induced illness in children are forms of child maltreatment, but beyond the scope of this article. Box 3 Injury features warranting further assessment1718 Incompatibility with development stage, for example, injury in a pre-mobile infant who is unable to self injure Inadequate explanation for injury regarding mechanism, severity, symptoms, or timing Patterned skin injuries that raise concern for injury with an object of that shape or outline Bruising in unusual locations, such as the ears, neck, abdomen, or buttocks Multiple or extensive unexplained injuries Rib and classic metaphyseal fractures in infants, which are highly associated with inflicted injury19 Supervision concern or delay in seeking care, although this may be subjective Examination At minimum, complete a skin and intra-oral examination in pre-mobile infants to decrease the chance of missing injuries.1516 Head circumference measurements in infants with non-specific neurological symptoms (such as vomiting without diarrhoea, irritability, abnormal movements, apnoea) can help detect possible intracranial causes, including haemorrhage from maltreatment.20 As in routine paediatric care, an increase in head circumference percentiles