Increased Vigilance, Training Needed to Identify Child Abuse in Infants

Published December 2021 | Pediatric Emergency Care

A physician in an emergency room or urgent care center is in an excellent position to identify possible child abuse in an infant who cannot yet speak or walk. By recognizing sentinel injuries, physicians can take appropriate—possibly lifesaving—action.

Research by Robert Shapiro, MD, and colleagues indicates targeted training of physicians may be needed. The study found that fewer than 50% of infants presenting to a pediatric emergency room or urgent care clinic with visible injuries were evaluated for child abuse. Children who were evaluated by a physician or nurse practitioner trained in pediatric emergency medicine were more likely to be evaluated for signs of abuse.

The study included infants aged 6 months or younger with visible injury who presented to pediatric hospital-affiliated emergency departments or urgent care in Ohio between July 2013 and January 2017. Visible injury was identified in 378 infants, 47% of whom did not receive a skeletal survey.

Many of the infants with bruising, burns or intraoral injuries who were evaluated for child abuse were indeed found to have further injuries: 25% had an occult fracture and 24% had intracranial hemorrhage. Occult fractures were also found in infants with apparently isolated abrasion/laceration (14%), subconjunctival hemorrhage (33%) and scalp hematoma/swelling (13%).

“In a preambulatory infant, injuries found on physical examination are important,” Shapiro says. “They’re often referred to as sentinel injuries because they indicate that additional trauma may exist. In such cases, X-rays of the entire skeleton and a computed tomography (CT) scan of the brain should be obtained to make sure there are no additional injuries that would indicate concern for physical child abuse.”