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    Cutaneous clues of child abuse

    Normal active children have their share of bumps and bruises. However when should cutaneous injuries alert pediatricians to abuse—and when are they signs of skin disorders unrelated to mistreatment?

    Due to the nature of this topic and its direct implication across specialties, this article was a collaboration with our sister publication, Dermatology Times.

    A skin manifestation can be a pediatrician’s first clue that a patient is being abused. Up to 90% of physical abuse victims present with cutaneous findings, such as bruises, lacerations, abrasions, burns, oral trauma, bite marks, and traumatic alopecia.1,2

    Yet, there is good evidence that minor signs of child physical abuse are missed regularly by unsuspecting physicians, according to Cindy Christian, MD, chair of Child Abuse and Neglect Prevention, The Children’s Hospital of Philadelphia.

    Recommended: 5 steps to a trauma-informed practice

    “This is especially true in young infants, who may present with minor bruising or other skin injuries. These infants are at significant risk for further, more serious injury,” Dr. Christian said.3 “Most physicians are aware that patterned injuries and multiple injuries are concerning for physical abuse, but may not consider a minor injury in a young infant as an indicator of abuse.”

    Prevalence, urgency

    Child abuse is one of the leading causes of death related to injury in infants and children.4 An estimated 1520 children died from abuse or neglect in 2013.5

    Physical abuse should be part of the differential diagnosis for all cutaneous and other injuries in children.6 Pediatricians are in unique position to identify and prevent child abuse.7

    The earlier the abuse is detected and stopped, the better. An abused child has about a 50% chance of being abused again, and is at an increased mortality risk if the abuse is not detected and stopped after the first presentation.4,8

    NEXT: What cutaneous clues may lead to a misdiagnosis?

    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.

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