Clinical Perspective

Abstract

Once a concerning illness or injury is identified, the history of present illness or injury (HPI) elicited from the caregiver(s) should include a detailed timeline beginning with a state of wellness, and/or the child’s typical baseline through to a description of illness or injury event(s). When specific event(s) are noted, caregiver(s) should be asked to share what and when event(s) happened, who was present, and what happened after event(s). For example, a history of a fall is a common injury event in cases of both physical abuse and accidental trauma. When a history of a fall is offered, fall components that should be elicited include what precipitated the fall, whether the child sustained a free fall or struck an object prior to landing, the height of the fall, how the child landed, landing surface and objects near the child’s landing location. In cases of abuse, although perpetrators may not accurately describe the actual abusive event, 76% of perpetrators initially accurately described the circumstances surrounding the abusive event; 64% initially mentioned a trigger for the abuse (Flaherty 2006).