How is physical child abuse differentiated from accidental injury?

Updated: Apr 24, 2017
  • Author: Angelo P Giardino, MD, MPH, PhD; Chief Editor: Caroly Pataki, MD  more...
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Determining whether an injury was inflicted by a caregiver or caused by accidental means is more than a medical determination, and the current and future safety and well being of the child and family are at stake. Many medical conditions may mimic some of the findings observed in physical abuse, and the differential diagnoses to consider differ depending on the types of physical, laboratory, and radiographic findings observed. Differential diagnoses should be worked through carefully in cases of suspected inflicted injury so that suspected physical abuse can be diagnosed confidently and caregivers are not inappropriately accused of abuse.

In all injuries, the major differential diagnosis is between accidental and inflicted injury. Determination of accident versus abuse is best accomplished by pairing thoughtful, thorough medical evaluation with information gathered through a multidisciplinary investigation, often involving child protective services (CPS) and law enforcement agencies.

Child physical abuse guidelines from the American Academy of Pediatrics (AAP) were updated in 2015 and include new information on the lasting effects of abuse and highlight risk factors for abuse and abusive injuries that are frequently overlooked. [24, 25]

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