child abuse

Signs of physical abuse in pre-cruising infants are often overlooked
Sentinel injuries are minor, unexplained injuries in pre-cruising infants that are often the first indication of physical abuse, which may precede more serious harm. In one study, more than 25% of abused infants had had a previous sentinel injury, and nearly half of the injuries were known to providers but went unaddressed.

Author/s:

Hannah McDowell, Suzanne Kathleen Robinson, Megan Cooney, Ashley Stewart-Tufescu, Tracie O. Afifi

Has This Child Experienced Physical Abuse? The Rational Clinical Examination Systematic Review

Megan George — Fri, 11 Jul 2025 13:37:15 +0000

Date Added:

July 11, 2025

Journal/Publication:

The Rational Clinical Examination

Publication Date:

April 21, 2025

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.2216.

Keywords

The Rational Clinical Examination

Trauma and Injury

child abuse

Psychiatry and Behavioral Health

Child and Adolescent Psychiatry

PMID (1):

40257808

MeSH

Craniocerebral Trauma

Fractures, Multiple

Guidance for clinicians regarding how to evaluate children for suspected child abuse. James W. Mold, MD, MPH

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Importance: Nearly 100 000 children experience physical abuse each year in the US. Among approximately 2000 annual deaths related to child maltreatment, more than 40% resulted from physical abuse, and half of those children were younger than 1 year. Many of these young children had unidentified abusive injuries before the fatal event.

Objective: To determine the accuracy of clinical and radiologic findings for identifying physical abuse among children who have sustained an injury.

Data Sources and Study Selection: MEDLINE, PubMed Central, and Embase were searched for articles published from 1970 to September 2024. Three authors identified studies describing clinical and radiologic characteristics in children and adolescents undergoing assessment for physical abuse.

Data Extraction and Synthesis: The number of children with and without each clinical or radiologic finding, and the presence or absence of physical abuse, which had been determined by expert panels, predefined criteria, or standardized scales that quantify the level of concern for abuse, were recorded.

Main Outcomes and Measures: The sensitivity, specificity, and likelihood ratios (LRs) of each finding for the presence of physical abuse were calculated and the range or calculated summary measures were reported when the finding was evaluated in more than 1 study.

Results: Of 7378 unique articles, 18 studies met inclusion criteria. The prevalence of physical abuse in these 18 studies ranged from 5% to 79%. Studies that were focused on skin findings in children evaluated for trauma showed that the presence of oral injury such as a torn frenulum (positive LR, 6.6 [95% CI, 3.2-14.0]), bruising on the buttocks (positive LR range, 15-83) or neck (positive LR range, 2.2-84), patterned bruises (positive LR range, 2.0-66), and subconjunctival hemorrhage (positive LR range, 5.4-130) were associated with increased likelihood of physical abuse. In studies of hospitalized children with head injury, the presence of retinal hemorrhages (positive LR, 11.0 [95% CI, 4.0-32.0]), seizures (positive LR, 3.9 [95% CI, 2.4-6.5]), hypoxic ischemic injury (positive LR, 3.4 [95% CI, 1.8-6.4]), or a subdural hematoma (positive LR, 3.2 [95% CI, 2.6-3.8]) increased the likelihood of physical abuse. In studies examining children who underwent skeletal surveys, a single fracture (positive LR, 5.9 [95% CI, 2.9-12.0]) or multiple fractures (positive LR, 3.8 [95% CI, 2.4-6.0]) increased the likelihood of physical abuse.

Conclusions and Relevance: A detailed physical examination that reveals oral injury, bruises on the buttocks or neck, patterned bruises, and subconjunctival hemorrhage in young children should alert clinicians to the possibility of physical abuse. Findings on neuroimaging and ophthalmologic evaluation in infants and young children with head trauma can help clinicians determine the likelihood of physical abuse.

Author/s:

Sonal N Shah, Hiu-Fai Fong, Suzanne B Haney, Mary Clyde Pierce, Nancy S Harper, Mark I Neuman

Has This Child Experienced Physical Abuse?: The Rational Clinical Examination Systematic Review

Erin Blanchette — Tue, 22 Apr 2025 21:51:53 +0000

Date Added:

April 22, 2025

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

April 21, 2025

URL:

Has This Child Experienced Physical Abuse?: The Rational Clinical Examination Systematic Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.2216

Keywords

physical abuse

child abuse

PMID (1):

40257808

MeSH

A review of the recommended evaluation of children who may have experienced physical abuse with case examples. James W. Mold, MD, MPH

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Importance: Nearly 100 000 children experience physical abuse each year in the US. Among approximately 2000 annual deaths related to child maltreatment, more than 40% resulted from physical abuse, and half of those children were younger than 1 year. Many of these young children had unidentified abusive injuries before the fatal event.

Objective: To determine the accuracy of clinical and radiologic findings for identifying physical abuse among children who have sustained an injury.

Data sources and study selection: MEDLINE, PubMed Central, and Embase were searched for articles published from 1970 to September 2024. Three authors identified studies describing clinical and radiologic characteristics in children and adolescents undergoing assessment for physical abuse.

Data extraction and synthesis: The number of children with and without each clinical or radiologic finding, and the presence or absence of physical abuse, which had been determined by expert panels, predefined criteria, or standardized scales that quantify the level of concern for abuse, were recorded.

Main outcomes and measures: The sensitivity, specificity, and likelihood ratios (LRs) of each finding for the presence of physical abuse were calculated and the range or calculated summary measures were reported when the finding was evaluated in more than 1 study.

Conclusions and relevance: A detailed physical examination that reveals oral injury, bruises on the buttocks or neck, patterned bruises, and subconjunctival hemorrhage in young children should alert clinicians to the possibility of physical abuse. Findings on neuroimaging and ophthalmologic evaluation in infants and young children with head trauma can help clinicians determine the likelihood of physical abuse.

Author/s:

Sonal N Shah, Hiu-Fai Fong, Suzanne B Haney, Nancy S Harper, Mary Clyde Pierce, Mark I Neuman

A Practical Guide To Conducting A Child Sexual Abuse Examination

Brian Desmarais — Mon, 23 Sep 2019 13:42:35 +0000

Date Added:

September 23, 2019

Journal/Publication:

Pediatrics and Child Health

Publication Date:

September 1, 2019

Issue:

Volume:

Pages:

448–454

URL:

A Practical Guide To Conducting A Child Sexual Abuse Examination

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1016/j.paed.2019.07.006

Keywords

child abuse

Sexual abuse

Examination

MeSH

referral and consultation

A review of how physicians should approach the evaluation of a child who may have been sexually abused. Unfortunately only the abstract is available for free, but the information it contains is useful, and those who need or want to know more can purchase the article. James W. Mold, MD, MPH

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If you work with children, then you are seeing children who have been sexually abused. Many presentations in a health setting go unrecognised.

It is a field of paediatric practice that has changed rapidly over the last fifteen years. The evidence base is now set out by the RCPCH, giving a much clearer steer on the interpretation of physical signs. There has been a shift from examinations being provided within a child protection rota, to being carried out by specialists in a Sexual Assault Referral Centre (SARC). In many places, this has meant regionalisation of the service, and in some places, provision outside the NHS. There has been a seismic cultural change in recognition of, and response to, sexual abuse in society as a whole.

Alongside this, the internet has created new ways of grooming and exploitation, and linked together those who seek to normalise CSA offending. The challenge to paediatrics (and to safeguarding and criminal justice systems), is to meet the need that these developments have exposed.

Author/s:

Gifford, J.

A Practical Guide To Conducting A Child Sexual Abuse Examination

Brian Desmarais — Mon, 23 Sep 2019 13:42:18 +0000

Date Added:

September 23, 2019

Journal/Publication:

Pediatrics and Child Health

Publication Date:

September 1, 2019

Issue:

Volume:

Pages:

448–454

URL:

A Practical Guide To Conducting A Child Sexual Abuse Examination

Type:

Community-Based Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.paed.2019.07.006

Keywords

child abuse

Sexual abuse

Examination

MeSH

referral and consultation

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If you work with children, then you are seeing children who have been sexually abused. Many presentations in a health setting go unrecognised.

Author/s:

Gifford, J.

A Systematic Review of Trials to Improve Child Outcomes Associated With Adverse Childhood Experiences

Tracy Ashby — Wed, 17 Apr 2019 05:00:00 +0000

Date Added:

April 17, 2019

Journal/Publication:

American Journal of Preventative Medicine

Publisher:

Elsevier Inc.

Publication Date:

March 13, 2019

Issue:

Volume:

Pages:

756-764

URL:

A Systematic Review of Trials to Improve Child Outcomes Associated With Adverse Childhood Experiences

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.amepre.2018.11.030

Keywords

adverse childhood experience

child

child abuse

psychology of violence

MeSH

substance-related disorders

domestic violence

primary health care

child health

parent-child relations

Screening for adverse childhood experiences and appropriate counseling and referral appears to positively impact outcomes. James W. Mold, MD, MPH

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Context

The purpose of this systematic literature review was to summarize current evidence from RCTs for the efficacy of interventions involving pediatric health care to prevent poor outcomes associated with adverse childhood experiences measured in childhood (C-ACEs).

Evidence acquisition

On January 18, 2018, investigators searched PubMed, PsycInfo, SocIndex, Web of Science, Cochrane, and reference lists for English language RCTs involving pediatric health care and published between January 1, 1990, and December 31, 2017. Studies were included if they were (1) an RCT, (2) on a pediatric population, and (3) recruited or screened based on exposure to C-ACEs. Investigators extracted data about the study sample and recruitment strategy, C-ACEs, intervention and control conditions, intermediate and child outcomes, and significant associations reported.

Evidence synthesis

A total of 22 articles describing results of 20 RCTs were included. Parent mental illness/depression was the most common C-ACE measured, followed by parent alcohol or drug abuse, and domestic violence. Most interventions combined parenting education, social service referrals, and social support for families of children aged 0–5years. Five of six studies that directly involved pediatric primary care practices improved outcomes, including three trials that involved screening for C-ACEs. Eight of 15 studies that measured child health outcomes, and 15 of 17 studies that assessed the parent–child relationship, demonstrated improvement.

Conclusions

Multicomponent interventions that utilize professionals to provide parenting education, mental health counseling, social service referrals, or social support can reduce the impact of C-ACEs on child behavioral/mental health problems and improve the parent–child relationship for children aged 0–5years.

Author/s:

Marie-Mitchell, Ariane, Kostolansky, Rashel