Child abuse includes physical, sexual and emotional harm and neglect by a caregiver, and EMS is often the first to see the home and the injuries. Clinicians do not need proof to act: a reasonable suspicion must be reported and the child must be kept safe.
Key symptoms
- Injuries that do not match the story or the child's development
- Delay in calling for help
- Bruises on the ears, neck, torso or buttocks, or any bruise in a baby who is not yet cruising
- Fearful, withdrawn or unusually quiet child
- Signs of neglect: poor hygiene, hunger, untreated illness
What you find on exam
- Primary survey and treat injuries first
- Bruise patterns: hand, loop, belt or bite marks
- Burns with sharp edges, cigarette marks or an immersion pattern
- Head injury signs in infants: irritability, vomiting, bulging fontanelle
- The home and caregiver behavior, without accusing anyone
Tests
- Detailed notes with exact quotes from the child and caregivers
- Hospital: skeletal survey in children under 2
- CT head when a head injury is suspected
- Blood count, coagulation and liver tests; eye exam for retinal bleeding
Treatment basics
- Treat injuries and transport to the hospital
- Stay calm and nonjudgmental; do not confront caregivers
- Avoid in-depth questioning; leave it to trained teams
- Report to child protective services or law enforcement as the law requires
- Tell the receiving team directly about your concerns
Red flags
- Any bruise in an infant under 4 months
- A changing or inconsistent history
- Siblings at home who may be at risk
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NCSBN 2026 NCLEX-RN Test Plan; NREMT psychomotor skill sheets (EMT and Paramedic). Written by Making Synapses. Making Synapses is not affiliated with these organizations.