Potentially life-threatening emergency
Physical child abuse - Suspected Child Abuse
Alerts and Notices
Synopsis
Abuse can occur by hitting, whipping, biting, kicking, choking, shaking, burning, or any physical means.
Population risk factors that have been identified to increase the potential for abuse may include young parents, children with special health care needs or developmental disorders, substance use or mental health issues in the home, and poverty.*
*Note: Risk factors are population risk factors and should never be relied on to decide who to further evaluate, who to report, when to worry about abuse, etc. Doing so may result in misdiagnosis and delay to diagnosis. The facts of the specific case are far more important than profiling who is at risk.
Related topics: bruise of child abuse, pediatric abusive head trauma, child sexual abuse
Codes
ICD10CM:T76.12XA – Child physical abuse, suspected, initial encounter
SNOMEDCT:
371779005 – Physical child abuse
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Hematologic:- Hemophilia
- Idiopathic thrombocytopenic purpura (ITP)
- Von Willebrand disease
- Immunoglobulin A vasculitis (formerly Henoch-Schönlein purpura)
- Phytophotodermatitis
- Congenital dermal melanocytosis (formerly Mongolian spot), nevus of Ito, nevus of Ota
- Vascular malformations (see arteriovenous malformation, venous malformation)
- Subcutaneous fat necrosis
- Disseminated intravascular coagulation (DIC)
- Cutaneous mastocytosis (urticaria pigmentosa, diffuse cutaneous mastocytosis)
- Langerhans cell histiocytosis
- Bullous impetigo
- Staphylococcal scalded skin syndrome
- Petechia or purpura from systemic bacterial or viral infection such as meningococcemia
In addition:
- The examining physician should be aware of culturally based practices such as cupping, coining, spooning, moxibustion, and caida de la mollera to be able to differentiate their accompanying signs from physical abuse.
- Dog-inflicted abrasions – This pattern can be mistaken for inflicted belt marks. With a scratch caused by a dog paw, the red lines are abraded; you should be able to feel the skin disruption. If the dog is large, the abrasions are often surrounded by bruising. In contrast, belt or cord marks are strips of bruising, typically without disruption of the skin surface and usually without a lot of surrounding bruising.
Best Tests
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Management Pearls
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Therapy
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References
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Last Reviewed:12/13/2022
Last Updated:03/12/2023
Last Updated:03/12/2023
Potentially life-threatening emergency
Physical child abuse - Suspected Child Abuse