Diagnostic evaluation of physical abuse in children

Abstract

The clinical approach to the evaluation of suspected physical abuse in children is briefly reviewed in this article. Child physical abuse refers to the infliction of injury on any part of a child's body. In 2006, 5,202 children were confirmed to be victims of child abuse in Korea. Among them 35% were classified as physical abuse. The physical abuse has usually been underreported because most injuries of childhood are not the result of abuse and an injury pattern is rarely pathognomonic for abuse or accident without careful consideration of the explanation provided. The medical assessment is outlined with respect to obtaining a history, physical examination, clinical manifestation, and appropriate ancillary testing. Detection of physical abuse is dependent on the doctor's ability to recognize suspicious injuries, such as bruising, bite marks, burns, and bone fractures. The physician should be able to recognize suspicious injuries, conduct a comprehensive and careful examination with appropriate auxiliary tests, critically assess the explanation provided for the injury, and establish the probability that the explanation does or does not correlate with the pattern, severity, and age of the injury. Suspected cases of child abuse should also be well documented and reported to the appropriate public agency which should assess the situation and help to protect the child.