Which specialist consultations are beneficial when physical child abuse is suspected?

Updated: Apr 24, 2017
  • Author: Angelo P Giardino, MD, MPH, PhD; Chief Editor: Caroly Pataki, MD  more...
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Answer

The following consultations may be warranted:

  • Pediatric radiologist expertise is important because many abusive fractures in infants are subtle on radiographs. Routine pediatric radiologist involvement is ideal. In locations where pediatric radiologists are not routinely available, one should be consulted in cases in which dating of bone injuries become central to the maltreatment investigation and when concerns arise regarding osteogenesis imperfecta (OI) or other bone mineralization problems.

  • Orthopedists can assist with diagnosis and management in cases of skeletal fractures of the long bones.

  • Hematologists can assist with diagnosis and management of bleeding disorders.

  • Geneticists may be needed for a detailed workup for OI or other collagen disorders for characterization of the collagen disorder.

  • Plastic surgeons may be needed to assist with the management of serious burns.

  • Ophthalmologists should be involved whenever abusive head trauma (AHT) is suspected, for a formal evaluation including examination of the eyes for retinal hemorrhages via dilated direct ophthalmoscope examination, ideally with retinal photography to allow for independent peer review.

  • Child psychiatrist, behavioral-developmental pediatrician, or psychiatric social worker may be needed to assess the mental health needs of the child and family, as well as to coordinate an overall psychosocial treatment plan.


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