Child Abuse Part 3: History, Exam, & Bruising

Course overview

Practitioners in primary care, particularly Pediatrics and Family Medicine, are uniquely poised to not only detect but also to prevent child abuse. In addition to primary care, practitioners in other acute-care specialties and environments bear the responsibility for early identification and reporting of suspected child abuse. These practice environments include Emergency Departments, Urgent Care centers, and clinics. Child physical abuse exists in all corners of the country and affects children of all ages, ethnicities and socioeconomic groups. The recognition and identification of child abuse is not an easy task. Not all practitioners are aware of the risk factors for abuse nor are they knowledgeable regarding the “sentinel injuries” that represent just the tip of the child abuse iceberg. In this activity, we address the critical importance of a detailed history and careful physical exam in the evaluation of a child for possible physical abuse. After completing this activity, learners should be able to: choose factors in the history provided by a caregiver that are suspicious for physical abuse in an injured child; distinguish the findings on physical exam that are consistent with physical abuse; and compare the features of accidental bruises and bruise mimics with bruises caused by abuse.