Child Abuse and Neglect

Examinations and Tests

A maltreated child who is taken to a health professional will first have a general physical examination. Also, the child's medical history will be reviewed, and parents or caregivers will be questioned about the child's condition. A child who is able to talk will be separated from the caregiver during the interview.

Health professionals have a professional duty and legal obligation to evaluate the possibility of abuse or neglect. Along with observing signs of physical abuse or neglect, a health professional may become suspicious when:

• The injury is uncommon or unlikely to be an accident, especially for the child's developmental stage.
• Explanations given by the parents or caregivers change or do not adequately account for the child's condition.
• There was no reported witness to the injury.
• Medical records document that similar injuries or patterns of neglect have occurred.
• Parents or caregivers delayed seeking medical help for the child without a credible or appropriate explanation.

Signs of sexual abuse may not be identified during a physical examination. Not all types of sexual abuse leave physical signs. Also, many types of sexual abuse injuries heal quickly. However, if a child is examined soon after the incident, a health professional is more likely to observe and record the symptoms and be able to take samples for lab analysis.

Common tests

Tests that are frequently used to help confirm or rule out suspected abuse or neglect include:

• Imaging tests such as X-ray, CT scan, or magnetic resonance imaging (MRI). These types of tests can help determine whether a child's injuries include any broken bones. Some tests may also show evidence of past injuries.
• Blood tests. Prothrombin time, partial thromboplastin time, and platelet count can help determine whether a bleeding disorder is present. This may help rule out abuse or neglect as a diagnosis. Other blood tests can be used to look for signs of organ damage.
• Urinalysis (UA), to check for blood in the urine. If the test is positive, this may be a sign of internal injuries.
• Specialized laboratory tests, to determine whether sexual abuse has occurred. For example, sample cultures of fluids found in or around the vagina may be taken and analyzed. If abuse has occurred within 72 hours of the examination, forensic samples of certain body tissues, such as skin or hair, also are taken.²
• Lumbar puncture, also called spinal tap, which may reveal blood from a brain injury.
• Eye examination by an ophthalmologist, to determine if damage has occurred that indicates shaken baby syndrome, also called intentional head injury.

Other tests

Other examinations and tests performed to help confirm child abuse or neglect vary depending on the specific medical problem suspected or observed. For example, psychological testing may be requested for some children. Victims of suspected sexual abuse may be tested for sexually transmitted infections.

Other children in the care of a suspected abuser may also be examined and have X-rays if law enforcement or medical personnel investigating the case think it is necessary.

When a baby's death may be related to sudden infant death syndrome (SIDS), medical professionals and police officers will conduct a thorough investigation to rule out abuse or neglect. These people are trained to be sensitive to grieving parents. No one is at fault when a baby dies from SIDS. For more information, see the topic Sudden Infant Death Syndrome (SIDS).

Documentation

A child's injuries and related information are carefully recorded. This documentation provides a detailed account of the injuries for the child's permanent health record and usually includes photographs and drawings of the injuries. Measurements (weight, height, and head circumference) are also taken and recorded to help establish a child's baseline growth pattern. Recording these measurements on growth charts can help identify failure to thrive that sometimes is related to neglect. Neglect or other types of abuse may not be diagnosed immediately.

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Author:	Carrie Henley Sabra L. Katz-Wise Ralph Poore	Last Updated: March 2, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Michael J. Sexton, MD - Pediatrics Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
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