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Diseases

Child abuse

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • Child abuse is a worldwide phenomenon that can affect children of all ages; however, the highest incidence of abuse occurs to infants and toddlers.

  • Four principal categories are defined: physical abuse, emotional abuse (also commonly referred to as psychological maltreatment), sexual abuse, and neglect. Children may fall under 1 or a combination of the different categories.

  • An ongoing process that can take place in a family, institutional, or community setting, either by someone close to the child, such as a parent or primary caregiver or, more rarely, by a stranger.

  • Determining whether injuries have been caused accidentally or represent abuse is often challenging. Finding 1 or more suspicious injuries in a child should warrant a full evaluation to look for other injuries typical of abuse.

  • While legislation such as mandatory reporting varies among countries, the overriding principle of "paramountcy" (i.e., that the welfare of the child is paramount) is universal.

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

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      • Diagnostics Tests

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        • Treatment Options

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          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Citations

            Key Articles

            • Suniega EA, Krenek L, Stewart G. Child abuse: approach and management. Am Fam Physician. 2022 May 1;105(5):521-8.[Abstract]

            • National Institute for Health and Care Excellence. Child abuse and neglect. Oct 2017 [internet publication].[Full Text]

            • Christian CW, Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 2015 May;135(5):e1337-54.[Abstract][Full Text]

            • Centers for Disease Control and Prevention. Child abuse and neglect prevention. Apr 2022 [internet publication].[Full Text]

            Other Online Resources

            • WHO: seven strategies for ending violence against children.

            Referenced Articles

            • 1. Hibbard R, Barlow J, Macmillan H, et al. Psychological maltreatment. Pediatrics. 2012 Aug;130(2):372-8.[Abstract][Full Text]

            • 2. Suniega EA, Krenek L, Stewart G. Child abuse: approach and management. Am Fam Physician. 2022 May 1;105(5):521-8.[Abstract]

            • 3. UK Health Security Agency. Working together to safeguard children: statutory guidance on inter-agency working to safeguard and promote the welfare of children. Jul 2022 [internet publication].​[Full Text]

            • 4. Hymel KP, Committee on Child Abuse and Neglect. When is lack of supervision neglect? Pediatrics. 2006 Sep;118(3):1296-8.[Abstract][Full Text]

            • 5. Ward MGK, Baird B. Medical neglect: working with children, youth, and families. Paediatr Child Health. 2022 Oct;27(6):372-81.[Abstract][Full Text]

            • 6. National Institute for Health and Care Excellence. Child abuse and neglect. Oct 2017 [internet publication].[Full Text]

            • 7. Tardieu A. Etude medico-legale sur les services et mauvais traitments exercés sur des enfants. Ann Hyg Pub Med Leg. 1860;13:361-98.

            • 8. Caffey J. Multiple fractures in the long bones of infants suffering from chronic subdural haematoma. Am J Roentgenol. 1946 Aug;56(2):163-73.

            • 9. Silverman FN. The roentgen manifestations of unrecognized skeletal trauma in infants. Am J Roentgenol Radium Ther Nucl Med. 1953 Mar;69(3):413-27.[Abstract]

            • 10. Christian CW, Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 2015 May;135(5):e1337-54.[Abstract][Full Text]

            • 11. ​Children's Bureau: an office of the Administration for Children & Families. Child maltreatment 2021. Jun 2023 [internet publication].[Full Text]

            • 12. Gilbert R, Spatz Widom C, Browne K, et al. Burden and consequences of child maltreatment in high income countries. Lancet. 2009 Jan 3;373(9657):68-81.[Abstract]

            • 13. Jouriles EN, McDonald R, Slep AM, et al. Child abuse in the context of domestic violence: prevalence, explanations, and practice implications. Violence Vict. 2008;23(2):221-35.[Abstract]

            • 14. Geffner R, Loring MT. The effects of intimate partner violence on children: part 2. J Emotional Abuse. 2003;3:155-7.

            • 15. Centers for Disease Control and Prevention. Child abuse and neglect prevention. Apr 2022 [internet publication].[Full Text]

            • 16. Sullivan PM, Knutson JF. The association between child maltreatment and disabilities in a hospital-based epidemiological study. Child Abuse Negl. 1998 Apr;22(4):271-88.[Abstract]

            • 17. Sidebotham PD, Heron J. The ALSPAC study team. Child maltreatment in the 'children of the nineties': the role of the child. Child Abuse Negl. 2003 Mar;27(3):337-52.[Abstract]

            • 18. Lee C, Barr RG, Catherine N, et al. Age-related incidence of publicly reported shaken baby syndrome cases: is crying a trigger for shaking? J Dev Behav Pediatr. 2007 Aug;28(4):288-93.[Abstract]

            • 19. Nelson HB, Martin CA. Increased child abuse in twins. Child Abuse Negl. 1985;9(4):501-5.[Abstract]

            • 20. Keenan HT, Runyan DK, Marshall SW, et al. A population-based study of inflicted traumatic brain injury in young children. JAMA. 2003 Aug 6;290(5):621-6.[Abstract][Full Text]

            • 21. Narang SK, Fingarson A, Lukefahr J, et al. Abusive head trauma in infants and children. Pediatrics. 2020 Apr;145(4):e20200203.[Abstract][Full Text]

            • 22. Hobbs C, Childs AM, Wynne J, et al. Subdural haematoma and effusion in infancy: an epidemiological study. Arch Dis Child. 2005 Sep;90(9):952-5.[Abstract][Full Text]

            • 23. Kemp AM, Stoodley N, Cobley C, et al. Apnoea and brain swelling in non-accidental head injury. Arch Dis Child. 2003 Jun;88(6):472-6; discussion 472-6.[Abstract][Full Text]

            • 24. Vinchon M, Defoort-Dhellemmes S, Desurmont M, et al. Accidental and nonaccidental head injuries in infants: a prospective study. J Neurosurg. 2005 May;102(4 Suppl):380-4.[Abstract]

            • 25. Ewing-Cobbs L, Prasad M, Kramer L, et al. Acute neuroradiologic findings in young children with inflicted or noninflicted traumatic brain injury. Childs Nerv Syst. 2000 Jan;16(1):25-33.[Abstract]

            • 26. Datta S, Stoodley N, Jayawant S, et al. Neuroradiological aspects of subdural haemorrhages. Arch Dis Child. 2005 Sep;90(9):947-51.[Abstract]

            • 27. Ichord RN, Naim M, Pollock AN, et al. Hypoxic-ischemic injury complicates inflicted and accidental traumatic brain injury in young children: the role of diffusion-weighted imaging. J Neurotrauma. 2007 Jan;24(1):106-18.[Abstract]

            • 28. Wood J, Rubin DM, Nance ML, et al. Distinguishing inflicted versus accidental abdominal injuries in young children. J Trauma. 2005 Nov;59(5):1203-8.[Abstract]

            • 29. Bulloch B, Schubert CJ, Brophy PD, et al. Cause and clinical characteristics of rib fractures in infants. Pediatrics. 2000 Apr;105(4):E48.[Abstract]

            • 30. Haney S, Scherl S, DiMeglio L, et al. Evaluating young children with fractures for child abuse: clinical report. Pediatrics. 2025 Feb 1;155(2):e2024070074.[Abstract][Full Text]

            • 31. Thomas SA, Rosenfield NS, Leventhal JM, et al. Long bone fractures in young children: distinguishing accidental injuries from child abuse. Pediatrics. 1991 Sep;88(3):471-6.[Abstract]

            • 32. Flaherty EG, Perez-Rossello JM, Levine MA, et al; American Academy of Pediatrics Committee on Child Abuse and Neglect. Evaluating children with fractures for child physical abuse. Pediatrics. 2014 Feb;133(2):e477-89.[Abstract][Full Text]

            • 33. Thackeray JD. Frena tears and abusive head injury: a cautionary tale. Pediatr Emerg Care. 2007 Oct;23(10):735-7.[Abstract]

            • 34. Cordner SM, Burke MP, Dodd MJ, et al. Issues in child homicides: 11 cases. Legal Medicine. 2001 Jun;3(2):95-103.[Abstract]

            • 35. Maguire S, Hunter B, Hunter L, et al; Welsh Child Protection Systematic Review Group. Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries. Arch Dis Child. 2007 Dec;92(12):1113-7.[Abstract][Full Text]

            • 36. Tate RJ. Facial injuries associated with the battered child syndrome. Br J Oral Surg. 1971 Jul;9(1):41-5.[Abstract]

            • 37. Fisher-Owens SA, Lukefahr JL, Tate AR, et al. Oral and dental aspects of child abuse and neglect. Pediatr Dent. 2017 Jul 15;39(4):278-83.[Abstract]

            • 38. Carrotte PV. An unusual case of child abuse. Br Dental J. 1990 Jun 9;168(11):444-5.[Abstract]

            • 39. Thackeray JD, Hibbard R, Dowd MD; Committee on Child Abuse and Neglect; Committee on Injury, Violence, and Poison Prevention. Intimate partner violence: the role of the pediatrician. Pediatrics. 2010 May;125(5):1094-100.[Abstract][Full Text]

            • 40. Royal College of Paediatrics and Child Health. Child protection companion - 2nd edition. 2013 [internet publication].[Full Text]

            • 41. Glaser D. Emotional abuse and neglect (psychological maltreatment): a conceptual framework. Child Abuse Negl. 2002 Jun;26(6-7):697-714.[Abstract]

            • 42. Block RW, Krebs NF, American Academy of Pediatrics Committee on Child Abuse and Neglect, et al. Failure to thrive as a manifestation of child neglect. Pediatrics. 2005 Nov;116(5):1234-7.[Abstract]

            • 43. Barlow J, Simpkiss D, Stewart Brown S. Interventions to prevent or ameliorate child physical abuse and neglect, findings from a systematic review. J Child Services. 2006 Nov 1;1(3):6-28.

            • 44. Zielinski DS, Eckenrode J, Olds DL. Nurse home visitation and the prevention of child maltreatment: impact on the timing of official reports. Dev Psychopathol. 2009 Spring;21(2):441-53.[Abstract]

            • 45. Klevens J, Whitaker DJ. Primary prevention of child physical abuse and neglect: gaps and promising directions. Child Maltreat. 2007 Nov;12(4):364-77.[Abstract]

            • 46. Oveisi S, Ardabili HE, Dadds MR, et al. Primary prevention of parent-child conflict and abuse in Iranian mothers: a randomized-controlled trial. Child Abuse Negl. 2010 Mar;34(3):206-13.[Abstract]

            • 47. Pinquart M, Teubert D. Effects of parenting education with expectant and new parents: a meta-analysis. J Fam Psychol. 2010 Jun;24(3):316-27.[Abstract]

            • 48. Segal L, Sara Opie R, Dalziel K. Theory! The missing link in understanding the performance of neonate/infant home-visiting programs to prevent child maltreatment: a systematic review. Milbank Q. 2012 Mar;90(1):47-106.[Abstract]

            • 49. Stirling J, Gavril A, Brennan B, et al. The pediatrician's role in preventing child maltreatment: clinical report. Pediatrics. 2024 Aug 1;154(2):e2024067608.[Abstract][Full Text]

            • 50. Dubowitz H, Feigelman S, Lane W, et al. Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) Model. Pediatrics. 2009 Mar;123(3):858-64.[Abstract]

            • 51. Dubowitz H, Lane WG, Semiatin JN, et al. The SEEK model of pediatric primary care: can child maltreatment be prevented in a low-risk population? Acad Pediatr. 2012 Jul-Aug;12(4):259-68.[Abstract]

            • 52. Barlow A, Mullany B, Neault N, et al. Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial. Am J Psychiatry. 2015 Feb 1;172(2):154-62.[Abstract][Full Text]

            • 53. Dias MS, Smith K, DeGuehery K, et al. Preventing abusive head trauma among infants and young children: a hospital-based, parent education program. Pediatrics. 2005 Apr;115(4):e470-7.[Abstract]

            • 54. Barr RG, Rivara FP, Barr M, et al. Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken-baby syndrome in mothers of newborns: a randomized, controlled trial. Pediatrics. 2009 Mar;123(3):972-80.[Abstract]

            • 55. Fujiwara T, Yamada F, Okuyama M, et al. Effectiveness of educational materials designed to change knowledge and behavior about crying and shaken baby syndrome: a replication of a randomized controlled trial in Japan. Child Abuse Negl. 2012 Sep;36(9):613-20.[Abstract]

            • 56. Mikton C, Butchart A. Child maltreatment prevention: a systematic review of reviews. Bull World Health Organ. 2009 May;87(5):353-61.[Abstract][Full Text]

            • 57. Selph SS, Bougatsos C, Blazina I, et al. Behavioral interventions and counseling to prevent child abuse and neglect: a systematic review to update the US Preventive services task force recommendation. Ann Intern Med. 2013 Feb 5;158(3):179-90.[Abstract][Full Text]

            • 58. Louwers EC, Affourtit MJ, Moll HA, et al. Screening for child abuse at emergency departments: a systematic review. Arch Dis Child. 2010 Mar;95(3):214-8.[Abstract]

            • 59. Louwers EC, Korfage IJ, Affourtit MJ, et al. Accuracy of a screening instrument to identify potential child abuse in emergency departments. Child Abuse Negl. 2014 Jul;38(7):1275-81.[Abstract][Full Text]

            • 60. Woodman J, Lecky F, Hodes D, et al. Screening injured children for physical abuse or neglect in emergency departments: a systematic review. Child Care Health Dev. 2010 Mar;36(2):153-64.[Abstract]

            • 61. Pierce MC, Kaczor K, Aldridge S, et al. Bruising characteristics discriminating physical child abuse from accidental trauma. Pediatrics. 2010 Jan;125(1):67-74.[Abstract]

            • 62. Hymel KP, Armijo-Garcia V, Foster R, et al. Validation of a clinical prediction rule for pediatric abusive head trauma. Pediatrics. 2014 Dec;134(6):e1537-44.[Abstract]

            • 63. Cowley LE, Morris CB, Maguire SA, et al. Validation of a prediction tool for abusive head trauma. Pediatrics. 2015 Aug;136(2):290-8.[Abstract]

            • 64. Sugar NF, Taylor JA, Feldman KW. Bruises in infants and toddlers; those who don't cruise rarely bruise. Puget Sound Pediatric Research Network. Arch Paediatr Adolesc Med. 1999 Apr;153(4):399-403.[Abstract][Full Text]

            • 65. Bishop N, Sprigg A, Dalton A. Unexplained fractures in infancy: looking for fragile bones. Arch Dis Child. 2007 Mar;92(3):251-6.[Abstract]

            • 66. Chiesa A, Duhaime AC. Abusive head trauma. Pediatr Clin North Am. 2009 Apr;56(2):317-31.[Abstract]

            • 67. Kelly P, John S, Vincent AL, et al. Abusive head trauma and accidental head injury: a 20-year comparative study of referrals to a hospital child protection team. Arch Dis Child. 2015 Dec;100(12):1123-30.[Abstract][Full Text]

            • 68. Manfield J, Oakley K, Macey JA, et al. Understanding the five-year outcomes of abusive head trauma in children: a retrospective cohort study. Dev Neurorehabil. 2021 Aug;24(6):361-7.[Abstract]

            • 69. Jayawant S, Rawlinson A, Gibbon F, et al. Subdural haemorrhages in infants: population based study. BMJ. 1998 Dec 5;317(7172):1558-61.[Abstract][Full Text]

            • 70. Badger S, Waugh MC, Hancock J, et al. Short term outcomes of children with abusive head trauma two years post injury: a retrospective study. J Pediatr Rehabil Med. 2020;13(3):241-53.[Abstract]

            • 71. Chevignard MP, Lind K. Long-term outcome of abusive head trauma. Pediatr Radiol. 2014 Dec;44 Suppl 4:S548-58.[Abstract]

            • 72. Jenny C, Hymel KP, Ritzen A, et al. Analysis of missed cases of abusive head trauma. JAMA. 1999 Feb 17;281(7):621-6.[Abstract]

            • 73. Maguire S, Pickerd N, Farewell D, et al. Which clinical features distinguish inflicted from non-inflicted brain injury? A systematic review. Arch Dis Child. 2009 Nov;94(11):860-7.[Abstract]

            • 74. Maguire SA, Kemp AM, Lumb RC, et al. Estimating the probability of abusive head trauma: a pooled analysis. Pediatrics. 2011 Sep;128(3):e550-64.[Abstract]

            • 75. Bhardwaj G, Chowdhury V, Jacobs MB, et al. A systematic review of the diagnostic accuracy of ocular signs in pediatric abusive head trauma. Ophthalmology. 2010 May;117(5):983-92.e17.[Abstract]

            • 76. Bechtel K, Stoessel K, Leventhal JM, et al. Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics. 2004 Jul;114(1):165-8.[Abstract]

            • 77. Carpenter SL, Abshire TC, Killough E, et al. Evaluating for suspected child abuse: conditions that predispose to bleeding. Pediatrics. 2022 Oct 1;150(4):e2022059277.[Abstract][Full Text]

            • 78. Hughes LA, May K, Talbot JF, et al. Incidence, distribution, and duration of birth-related retinal hemorrhages: a prospective study. J AAPOS. 2006 Apr;10(2):102-6.[Abstract]

            • 79. Maguire SA, Watts PO, Shaw AD, et al. Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review. Eye (Lond). 2013 Jan;27(1):28-36.[Abstract][Full Text]

            • 80. Vinchon M, Noulé N, Tchofo PJ, et al. Imaging of head injuries in infants: temporal correlates and forensic implications for the diagnosis of child abuse. J Neurosurg. 2004;101(2 Suppl):44-52.[Abstract]

            • 81. Shugerman RP, Paez A, Grossman DC, et al. Epidural hemorrhage: is it abuse? Pediatrics. 1996 May;97(5):664-8.[Abstract]

            • 82. Silverman LB, Lindberg DM, O'Neill BR, et al. Cytotoxic edema in pediatric abusive head trauma: adopting a common nomenclature. J Neuroimaging. 2019 Mar;29(2):272-3.[Abstract]

            • 83. Gabos PG, Tuten HR, Leet A, et al. Fracture-dislocation of the lumbar spine in an abused child. Pediatrics. 1998 Mar;101(3 Pt 1):473-7.[Abstract]

            • 84. Katz JS, Oluigbo CO, Wilkinson CC, et al. Prevalence of cervical spine injury in infants with head trauma. J Neurosurg Pediatr. 2010 May;5(5):470-3.[Abstract]

            • 85. Oral R, Rahhal R, Elshershari H, et al. Intentional avulsion fracture of the second cervical vertebra in a hypotonic child. Pediatr Emerg Care. 2006 May;22(5):352-4.[Abstract]

            • 86. Diamond P, Hansen CM, Christofersen MR. Child abuse presenting as a thoracolumbar spinal fracture dislocation: a case report. Pediatr Emerg Care. 1994 Apr;10(2):83-6.[Abstract]

            • 87. Kemp AM, Joshi AH, Mann M, et al. What are the clinical and radiological characteristics of spinal injuries from physical abuse: a systematic review. Arch Dis Child. 2010 May;95(5):355-60.[Abstract]

            • 88. Cullen JC. Spinal lesions in battered babies. J Bone Joint Surg (Br). 1975 Aug;57(3):364-6.[Abstract]

            • 89. Barnes PM, Norton CM, Dunstan FD, et al. Abdominal injury due to child abuse. Lancet. 2005 Jul 16-22;366(9481):234-5.[Abstract]

            • 90. Wegner S, Colletti JE, Van Wie D. Pediatric blunt abdominal trauma. Pediatr Clin North Am. 2006 Apr;53(2):243-56.[Abstract]

            • 91. Belfer RA, Klein BL, Orr L. Use of the skeletal survey in the evaluation of child maltreatment. Am J Emerg Med. 2001 Mar;19(2):122-4.[Abstract]

            • 92. Leventhal JM, Thomas SA, Rosenfield NS, et al. Fractures in young children. Distinguishing child abuse from unintentional injuries. Am J Dis Child. 1993 Jan;147(1):87-92.[Abstract]

            • 93. Kemp AM, Dunstan F, Harrison S, et al. Patterns of skeletal fractures in child abuse: systematic review. BMJ. 2008 Oct 2;337:a1518.[Abstract][Full Text]

            • 94. Worlock P, Stower M, Barbor P. Patterns of fractures in accidental and non-accidental injury in children: a comparative study. BMJ. 1986 Jul 12;293(6539):100-2.[Abstract][Full Text]

            • 95. Barsness KA, Cha ES, Bensard DD, et al. The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. J Trauma. 2003 Jun;54(6):1107-10.[Abstract]

            • 96. Garcia VF, Gotschall CS, Eichelberger MR, et al. Rib fractures in children: a marker of severe trauma. J Trauma. 1990 Jun;30(6):695-700.[Abstract]

            • 97. Cadzow SP, Armstrong KL. Rib fractures in infants: Red alert! The clinical features, investigations and child protection outcomes. J Paediatr Child Health. 2000 Aug;36(4):322-6.[Abstract]

            • 98. Kleinman PK. Diagnostic imaging of child abuse. Maryland Heights, MO: Mosby; 1998.

            • 99. Kleinman PK. Problems in the diagnosis of metaphyseal fractures. Pediatr Radiol. 2008 Jun;38 Suppl 3:S388-94.[Abstract]

            • 100. Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus fractures. J Pediatr Orthop. 1998 Jan-Feb;18(1):38-42.[Abstract]

            • 101. Meservy CJ, Towbin R, McLaurin RL, et al. Radiographic characteristics of skull fractures resulting from child abuse. AJR Am J Roentgenol. 1987 Jul;149(1):173-5.[Abstract][Full Text]

            • 102. Reece RM, Sege R. Childhood head injuries: accidental or inflicted? Arch Pediatr Adolesc Med. 2000 Jan;154(1):11-5.[Abstract][Full Text]

            • 103. Pandya NK, Baldwin K, Kamath AF, et al. Unexplained fractures: child abuse or bone disease? A systematic review. Clin Orthop Relat Res. 2011 Mar;469(3):805-12.[Abstract][Full Text]

            • 104. Sink EL, Hyman JE, Matheny T, et al. Child abuse: the role of the orthopaedic surgeon in nonaccidental trauma. Clin Orthop Relat Res. 2011 Mar;469(3):790-7.[Abstract][Full Text]

            • 105. Naidoo S. A profile of the oro-facial injuries in child physical abuse at a children's hospital. Child Abuse Negl. 2000 Apr;24(4):521-34.[Abstract]

            • 106. Becker DB, Needleman HL, Kotelchuck M. Child abuse and dentistry: orofacial trauma and its recognition by dentists. J Am Dent Assoc. 1978 Jul;97(1):24-8.[Abstract]

            • 107. Schuman NJ, Hamilton RL. Discovery of child abuse with associated dental fracture in a hospital-affiliated clinic: report of a case with a four-year follow up. Spec Care Dent. 1982 Nov-Dec;2(6):250-1.[Abstract]

            • 108. Tate AR, Fisher-Owens SA, Spiller L, et al. Oral and dental aspects of child abuse and neglect: clinical report. Pediatrics. 2024 Sep 1;154(3):e2024068024.[Abstract][Full Text]

            • 109. Andreasen JO. Challenges in clinical dental traumatology. Endodont Dent Traumatol. 1985 Apr;1(2):45-55.[Abstract]

            • 110. McMahon P, Grossman W, Gaffney M, et al. Soft-tissue injury as an indication of child abuse. J Bone Joint Surg Am. 1995 Aug;77(8):1179-83.[Abstract]

            • 111. Ward MG, Ornstein A, Niec A, et al; Canadian Pediatric Society. The medical assessment of bruising in suspected child maltreatment cases: a clinical perspective. Paediatr Child Health. 2013 Oct;18(8):433-42.[Abstract][Full Text]

            • 112. Carpenter RF. The prevalence and distribution of bruising in babies. Arch Dis Child. 1999 Apr;80(4):363-6.[Abstract]

            • 113. Dunstan FD, Guildea ZE, Kontos K, et al. A scoring system for bruise patterns: a tool for identifying abuse. Arch Dis Child. 2002 May;86(5):330-3.[Abstract][Full Text]

            • 114. Chang LT, Tsai MC. Craniofacial injuries from slip, trip, and fall accidents of children. J Trauma. 2007 Jul;63(1):70-4.[Abstract]

            • 115. Atwal GS, Rutty GN, Carter N, et al. Bruising in non-accidental head injured children; a retrospective study of the prevalence, distribution and pathological associations in 24 cases. Forensic Sci Int. 1998 Sep 28;96(2-3):215-30.[Abstract]

            • 116. de Silva S, Oates RK. Child homicide - the extreme of child abuse. Med J Aust. 1993 Mar 1;158(5):300-1.[Abstract]

            • 117. Ghahreman A, Bhasin V, Chaseling R, et al. Nonaccidental head injuries in children: a Sydney experience. J Neurosurg. 2005 Sep;103(3 Suppl):213-8.[Abstract]

            • 118. Nayak K, Spencer N, Shenoy M, et al. How useful is the presence of petechiae in distinguishing non-accidental from accidental injury? Child Abuse Negl. 2006 May;30(5):549-55.[Abstract]

            • 119. Maguire S, Mann M. Systematic reviews of bruising in relation to child abuse-what have we learnt: an overview of review updates. Evid Based Child Health. 2013 Mar 7;8(2):255-63.[Abstract]

            • 120. Smith SM, Hanson R. 134 battered children: a medical and psychological study. Br Med J. 1974 Sep 14;3(5932):666-70.[Abstract][Full Text]

            • 121. Peters ML, Starling SP, Barnes-Eley ML, et al. The presence of bruising associated with fractures. Arch Pediatr Adolesc Med. 2008 Sep;162(9):877-81.[Abstract][Full Text]

            • 122. Baker MD, Moore SE. Human bites in children. A six-year experience. Am J Dis Child. 1987 Dec;141(12):1285-90.[Abstract]

            • 123. Freeman AJ, Senn DR, Arendt DM. Seven hundred seventy eight bite marks: analysis by anatomic location, victim and biter demographics, type of crime, and legal disposition. J Forens Sci. 2005 Nov;50(6):1436-43.[Abstract]

            • 124. American Board of Forensic Odontology. ID & bitemark guidelines: body identification information & guidelines. Feb 2017 [internet publication].[Full Text]

            • 125. Levine LJ. Bite marks in child abuse. In: Sanger RG, Bross DC, eds. Clinical management of child abuse and neglect. Chicago, IL: Quintessence; 1984:53-9.

            • 126. Whittaker DK, MacDonald DG. Bitemarks in flesh. In: A colour atlas of forensic dentistry. London, UK: Wolfe Medical Publications; 1989:108.

            • 127. Yin S. Malicious use of pharmaceuticals in children. J Pediatr. 2010 Nov;157(5):832-6.e1.[Abstract]

            • 128. Dressler DP, Hozid JL. Thermal injury and child abuse: the medical evidence dilemma. J Burn Care Rehabil. 2001 Mar-Apr;22(2):180-5.[Abstract]

            • 129. Feldman KW. Help needed on hot water burns. Pediatrics. 1983 Jan;71(1):145-6.[Abstract]

            • 130. Hobbs CJ. When are burns not accidental? Arch Dis Child. 1986 Apr;61(4):357-61.[Abstract][Full Text]

            • 131. Yeoh C, Nixon JW, Dickson W, et al. Patterns of scald injuries. Arch Dis Child. 1994 Aug;71(2):156-8.[Abstract][Full Text]

            • 132. Daria S, Sugar NF, Feldman KW, et al. Into hot water head first: distribution of intentional and unintentional immersion burns. Pediatr Emerg Care. 2004 May;20(5):302-10.[Abstract]

            • 133. Allasio D, Fischer H. Immersion scald burns and the ability of young children to climb into a bathtub. Pediatrics. 2005 May;115(5):1419-21.[Abstract]

            • 134. Johnson CF, Ericson AK, Caniano D. Walker-related burns in infants and toddlers. Pediatr Emerg Care. 1990 Mar;6(1):58-61.[Abstract]

            • 135. Sheridan RL. Recognition and management of hot liquid aspiration in children. Ann Emerg Med. 1996 Jan;27(1):89-91.[Abstract]

            • 136. Titus MO, Baxter AL, Starling SP. Accidental scald burns in sinks. Pediatrics. 2003 Feb;111(2):E191-4.[Abstract]

            • 137. Zaloga WF, Collins KA. Pediatric homicides related to burn injury: a retrospective review at the Medical University of South Carolina. J Forensic Sci. 2006 Mar;51(2):396-9.[Abstract]

            • 138. Hicks RA, Stolfi A. Skeletal surveys in children with burns caused by child abuse. Pediatr Emerg Care. 2007 May;23(5):308-13.[Abstract]

            • 139. Maguire S, Moynihan S, Mann M, et al. A systematic review of the features that indicate intentional scalds in children. Burns. 2008 Dec;34(8):1072-81. [Abstract]

            • 140. Purdue GF, Hunt JL, Prescott PR. Child abuse by burning - an index of suspicion. J Trauma. 1988 Feb;28(2):221-4.[Abstract]

            • 141. Stratman E, Melski J. Scald abuse. Arch Dermatol. 2002 Mar;138(3):318-20.[Abstract]

            • 142. Darok M, Reischle S. Burn injuries caused by a hair-dryer: an unusual case of child abuse. Forensic Sci Int. 2001 Jan 1;115(1-2):143-6.[Abstract]

            • 143. Grellner W, Metzner G. Child abuse caused by thermal violence - determination and reconstruction. Arch Kriminol. 1995 Jan-Feb;195(1-2):38-46.[Abstract]

            • 144. Johnson CF. Symbolic scarring and tattooing: unusual manifestations of child abuse. Clin Pediatr. 1994 Jan;33(1):46-9.[Abstract]

            • 145. Kini N, Lazoritz S, Ott C, et al. Caustic instillation into the ear as a form of child abuse. Am J Emerg Med. 1997 Jul;15(4):442-3.[Abstract]

            • 146. Telmon N, Allery JP, Dorandeu A, et al. Concentrated bleach burns in a child. J Forensic Sci. 2002 Sep;47(5):1060-1.[Abstract]

            • 147. Winek CL, Wahba WW, Huston RM. Chemical burn from alkaline batteries - a case report. Forensic Sci Int. 1999 Mar 15;100(1-2):101-4.[Abstract]

            • 148. Zurbuchen P, LeCoultre C, Calza AM, et al. Cutaneous necrosis after contact with calcium chloride: a mistaken diagnosis of child abuse. Pediatrics. 1996 Feb;97(2):257-8.[Abstract]

            • 149. The Royal College of Radiologists, The Society and College of Radiographers. The radiological investigation of suspected physical abuse in children. Dec 2018 [internet publication].[Full Text]

            • 150. American College of Radiology. ACR-SPR practice parameter for the performance and interpretation of skeletal surveys in children. 2021[internet publication].​[Full Text]

            • 151. Kemp AM, Butler A, Morris S, et al. Which radiological investigations should be performed to identify fractures in suspected child abuse? Clin Radiol. 2006 Sep;61(9):723-36.[Abstract]

            • 152. Anderst J, Carpenter SL, Abshire TC, et al. Evaluation for bleeding disorders in suspected child abuse. Pediatrics. 2022 Oct 1;150(4):e2022059276.[Abstract][Full Text]

            • 153. Lane WG, Dubowitz H, Langenberg P. Screening for occult abdominal trauma in children with suspected physical abuse. Pediatrics. 2009 Dec;124(6):1595-602.[Abstract]

            • 154. Bevan CA, Palmer CS, Sutcliffe JR, et al. Blunt abdominal trauma in children: how predictive is ALT for liver injury? Emerg Med J. 2009 Apr;26(4):283-8.[Abstract]

            • 155. Fortin K, Wood JN. Utility of screening urinalysis to detect abdominal injuries in suspected victims of child physical abuse. Child Abuse Negl. 2020 Nov;109:104714.[Abstract]

            • 156. Servaes S, Brown SD, Choudhary AK, et al. The etiology and significance of fractures in infants and young children: a critical multidisciplinary review. Pediatr Radiol. 2016 May;46(5):591-600.[Abstract]

            • 157. Kemp AM, Rajaram S, Mann M, et al; Welsh Child Protection Systematic Review Group. What neuroimaging should be performed in children in whom inflicted brain injury (iBI) is suspected? A systematic review. Clin Radiol. 2009 May;64(5):473-83.[Abstract]

            • 158. Expert Panel on Pediatric Imaging: Wootton-Gorges SL, Soares BP, et al. ACR Appropriateness Criteria(®) Suspected physical abuse-child. J Am Coll Radiol. 2017 May;14(5S):S338-49.[Abstract]

            • 159. Rubin DM, Christian CW, Bilaniuk LT, et al. Occult head injury in high-risk abused children. Pediatrics. 2003 Jun;111(6 Pt 1):1382-6.[Abstract]

            • 160. American College of Radiology. ACR Appropriateness Criteria: head trauma - child. 2014 [internet publication].[Full Text]

            • 161. Kemp AM, Jaspan T, Griffiths J, et al. Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review. Arch Dis Child. 2011 Dec;96(12):1103-12.[Abstract]

            • 162. Paddock M, Choudhary AK, Jeanes A, et al. Controversial aspects of imaging in child abuse: a second roundtable discussion from the ESPR child abuse taskforce. Pediatr Radiol. 2023 Apr;53(4):739-51.[Abstract][Full Text]

            • 163. Fischman SL. Bite marks. Alpha Omegan. 2002 Dec;95(4):42-6.[Abstract]

            • 164. Baxter AL, Lindberg DM, Burke BL, et al. Hepatic enzyme decline after pediatric blunt trauma: a tool for timing child abuse? Child Abuse Negl. 2008 Sep;32(9):838-45.[Abstract]

            • 165. Keeshin B, Forkey HC, Fouras G, et al. Children Exposed to Maltreatment: Assessment and the Role of Psychotropic Medication. Pediatrics. 2020 Feb;145(2).[Abstract][Full Text]

            • 166. National Institute for Health and Care Excellence. Child maltreatment: when to suspect maltreatment in under 18s. Oct 2017 [internet publication].[Full Text]

            • 167. Romanelli LH, Landsverk J, Levitt JM, et al; Child Welfare-Mental Health Best Practices Group. Best practices for mental health in child welfare: screening, assessment, and treatment guidelines. Child Welfare. 2009;88(1):163-88.[Abstract]

            • 168. US Department of Health & Human Services. Mandatory reporters of child abuse and neglect. 2019 [internet publication].[Full Text]

            • 169. Canadian Paediatric Society. Multidisciplinary guidelines on the identification, investigation and management of suspected abusive head trauma. December 2007 [internet publication].[Full Text]

            • 170. Keenan HT, Runyan DK, Marshall SW, et al. A population-based comparison of clinical and outcome characteristics of young children with serious inflicted and noninflicted traumatic brain injury. Pediatrics. 2004 Sep;114(3):633-9.[Abstract]

            • 171. Lane WG, Lotwin I, Dubowitz H, et al. Outcomes for children hospitalized with abusive versus noninflicted abdominal trauma. Pediatrics. 2011 Jun;127(6):e1400-5.[Abstract][Full Text]

            • 172. Nakarmi KK, Pathak BD, Shrestha D, et al. Comparison of accidental pediatric scald burns in a tertiary care center: hot cauldron burns versus accidental spill burns. F1000Res. 2021;10:1086.[Abstract][Full Text]

            • 173. Danese A, Moffitt TE, Harrington H, et al. Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Arch Pediatr Adolesc Med. 2009 Dec;163(12):1135-43.[Abstract][Full Text]

            • 174. Wegman HL, Stetler C. A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood. Psychosom Med. 2009 Oct;71(8):805-12.[Abstract]

            • 175. Rivera B, Widom CS. Childhood victimization and violent offending. Violence Vict. 1990 Spring;5(1):19-35.[Abstract]

            • 176. Luntz BK, Widom CS. Antisocial personality disorder in abused and neglected children grown up. Am J Psychiatry. 1994 May;151(5):670-4.[Abstract]

            • 177. Afifi TO, Fortier J, Sareen J, et al. Associations of harsh physical punishment and child maltreatment in childhood with antisocial behaviors in adulthood. JAMA Netw Open. 2019 Jan 4;2(1):e187374.[Abstract][Full Text]

            • 178. Yang BZ, Zhang H, Ge W, et al. Child abuse and epigenetic mechanisms of disease risk. Am J Prev Med. 2013 Feb;44(2):101-7.[Abstract][Full Text]

            • 179. Leeb RT, Lewis T, Zolotor AJ. A review of physical and mental health consequences of child abuse and neglect and implications for practice. Am J Lifestyle Med. 2011 Jun 3;5(5):454-8.

            • 180. Perez CM, Widom CS. Childhood victimization and long-term intellectual and academic outcomes. Child Abuse Negl. 1994 Aug;18(8):617-33.[Abstract]

            • 181. Anderson V, Catroppa C, Morse S, et al. Intellectual outcome from preschool traumatic brain injury: a 5-year prospective, longitudinal study. Pediatrics. 2009 Dec;124(6):e1064-71.[Abstract]

            • 182. Block RW. Follow-up skeletal surveys prove to be valuable in evaluation of child physical abuse. Child Abuse Negl. 2005 Oct;29(10):1073-4.[Abstract]

            • 183. Harlan SR, Nixon GW, Campbell KA, et al. Follow-up skeletal surveys for nonaccidental trauma: can a more limited survey be performed? Pediatr Radiol. 2009 Sep;39(9):962-8.[Abstract]

            • 184. MacMillan HL, Wathen CN, Barlow J, et al. Interventions to prevent child maltreatment and associated impairment. Lancet. 2009 Jan 17;373(9659):250-66.[Abstract]

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