Child abuse includes physical, sexual and emotional abuse and neglect by a parent or caregiver, and it is often hidden behind a story that does not fit the injury. Every health worker in the US is a mandated reporter, so suspicion alone is enough to report to child protective services.
Key symptoms
- History that changes or does not match the injury or the child's age
- Delay in seeking care
- Behavior changes: fear, withdrawal, aggression, regression
- Poor growth, poor hygiene, missed care (neglect)
- Sexual knowledge or behavior unusual for age
What you find on exam
- Full skin check, including ears, neck, torso and buttocks
- Bruises in a non-mobile infant or in patterned shapes such as a hand or loop
- Burns with clear edges, such as immersion or cigarette burns
- Retinal hemorrhages, bulging fontanelle, changes in alertness
Tests
- Skeletal survey in children under 2 years
- Head CT or MRI if head injury is possible
- Blood count and clotting tests to rule out a bleeding disorder
- Liver enzymes, lipase and urinalysis for hidden abdominal injury
Treatment basics
- Treat injuries and make sure the child is safe, admitting if needed
- Report to child protective services as soon as abuse is suspected
- Document exact quotes, injuries and photos objectively
- Involve a child abuse team and social work
- Check siblings and other children in the home
Red flags
- Any bruise in an infant who is not yet crawling
- Head injury with vomiting, seizures or drowsiness
- Fractures of different ages or rib fractures
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Sources: NCSBN 2026 NCLEX-RN Test Plan; NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.