Children who have suffered physical abuse may present to the healthcare setting multiple times before a diagnosis is made. Emergency clinicians must be able to recognize sentinal and severe signs of nonaccidental trauma and pursue an appropriate evaluation to prevent further injury.
Our recent issue Emergency Department Evaluation and Management of Nonaccidental Trauma in Pediatric Patients offers evidence-based recommendations for the identification and management of nonaccidental trauma in children.
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Here are a few key points:
- Examples of sentinel injuries include unusual bruising in infants and toddlers, and intraoral injuries such as a torn frenulum in infants. Inadequately explained or patterned burns (eg, cigarette burns), and fractures in premobile children can also be signs of nonaccidental trauma (NAT). (See Figure 1 in the issue.)
- Distinguishing routine accidental bruising from abusive bruising patterns is important when evaluating an injured child. (See Figure 2.)
- When obtaining the history, ask open-ended questions and allow caregivers/parents to give their full side of the story, so as not to influence the narrative with leading questions.
- Injuries that seem inconsistent with the child’s developmental age, certain injury patterns, traumatic injuries in preambulatory children, or delays to seeking care should prompt clinicians to move NAT further up the differential.