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- Jill C. Glick, MD*
- Michele A. Lorand, MD†
- Kristen R. Bilka, MMS, PA-C‡
- *Department of Pediatrics, University of Chicago; Medical Director, Child Advocacy and Protective Services, University of Chicago Comer Children’s Hospital, Chicago, IL.
- †Division of Child Protective Services, Department of Pediatrics; Medical Director, Chicago Children's Advocacy Center, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL.
- ‡Department of Pediatrics, University of Chicago; Physician Assistant, Child Advocacy and Protective Services, University of Chicago Comer Children’s Hospital, Chicago, IL.
AUTHOR DISCLOSURE
Drs Glick and Lorand and Ms Bilka have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Editor’s Note
This article stresses the importance of the “sentinel injury,” a physical injury that is unusual for the age of the child and may herald more serious injuries, thereby necessitating further evaluation.Joseph A. Zenel, MD
Editor-in-Chief
Practice Gap
Before receiving a diagnosis of child abuse, 25% to 30% of abused infants have “sentinel” injuries, such as facial bruising, noted by clinicians or caregivers. (1)(2)(3)(4)(5)(6) Although easily overlooked and often considered minor, such injuries are harbingers warning clinicians that pediatric patients require further assessment. Appropriate intervention is critical, and the clinician plays a major role in identifying children who present with signs or symptoms concerning for child physical abuse by ensuring appropriate and expeditious medical evaluations and reports to child protective services.
Objectives
After completing this article, the reader should be able to:
Identify which injured children require a child abuse evaluation.
Recognize subtle signs and nonspecific symptoms of major trauma in infants.
Understand sentinel injuries and their significance.
Know which laboratory and imaging studies to obtain when child physical abuse is suspected.
Understand the legal obligation to report children with injuries that are suspicious for physical abuse and develop a thoughtful approach to informing parents of this legal obligation.
Case Presentation
A private practice pediatrician receives a phone call from a community emergency department (ED) physician regarding one of her patients, a 4-month-old infant being treated for bronchiolitis. The ED physician informs her that the baby’s chest radiograph has revealed multiple posterior rib fractures in different stages of healing, and physical examination shows a cluster of small bruises on her cheek. The …
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- Article
- Editor’s Note
- Practice Gap
- Objectives
- Case Presentation
- Introduction
- Epidemiology
- Risk Factors for Child Physical Abuse
- When to Consider the Diagnosis of Child Physical Abuse
- History of the Present Illness and Child Physical Abuse
- Physical Examination and Diagnostic Evaluation
- Abusive Head Trauma
- Cutaneous Injuries
- Skeletal Injuries
- Imaging of Skeletal Injuries
- Chest and Abdominal Injuries
- Reporting to Child Welfare and the Role of the Clinician
- Prevention and Future Horizons
- References
- Figures & Data
- Supplemental
- Info & Metrics
- Comments
- Quiz