Neglected Child Evaluation
The evaluation of child abuse requires a complete history and physical examination. The history surrounding the injury can provide important clues that point toward abuse. Abused children may be too young to give a clear history.
Physical findings of abuse may not be present.
Testing may be required to look for signs of old injuries.
Tests that may be used to evaluate child abuse include:
Neglected Child Clues of Abuse
Clues of child abuse include:
- The historical features of an injury are inconsistent with the type or severity of injuries
- Poisoning in an infant: infants less than 6 months old are not able to cause an accident
- Child and parent offer stories that are not consistent
- The historical features keep changing as more questions are asked
- Similar injuries have occurred in siblings
- The caregiver delays seeking treatment
- The caregiver and child show abnormal social interaction
Neglected Child Munchausen-by-Proxy
Munchausen-by-proxy syndrome is a serious mental illness in child caregivers. The caregiver creates false signs and symptoms of disease in the child. The abuser does this to satisfy his or her abnormal need for attention. By claiming that the child is sick, the caregiver has constant contact with doctors and hospitals. As a result, children undergo unnecessary testing and treatment for false illnesses.
Neglected Child Physical Findings
Facts about child abuse:
- An exam may reveal signs of prior physical abuse, such as burns, healing bruises, or healing lacerations.
- Common child abuse findings on exam include cigarette burns, limb swelling, limping, odd-shaped bruises.
- Bruising that involves a body region not usually injured in a fall: the surface of the buttocks, back, or pelvis.
- X-rays may show healing fractures of the ribs, skull, or long bones.
Neglected Child Sexual Abuse
About one-fourth of all girls and one-sixth of all boys are sexually abused before adulthood. A careful history and physical exam by a doctor can often reveal clues to this diagnosis. An evaluation should include tests for sexually transmitted disease.
Neglected Child Shaken Baby Syndrome
Shaken Baby Syndrome
Head injuries are a common cause of death in child abuse victims. Injury to the head can cause serious damage to the brain. A special case, called the shaken baby syndrome, is the violent shaking of a child by an abusive caregiver. As the head violently moves back and forth, arteries in the neck are torn and bleeding occurs in the brain: this can result in death.
Continue to Neglected Child Treatment
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- Ledbetter EO. An ethical approach to intervention/prevention of child maltreatment. Adv Pediatr. 2003;50:215-29. 
- Tenney-Soeiro R, Wilson C. An update on child abuse and neglect. Curr Opin Pediatr. 2004 Apr;16(2):233-7. 
- Tolan P, Gorman-Smith D, Henry D. Family Violence. Annu Rev Psychol. 2005 Aug 31.