Recognizing Child Abuse on the USMLE exams.
- Suspected child abuse requires your BY LAW to report the suspected abuse.
- You must also explain to the parents why you suspect abuse and that you are legally obligated to report it to child protective services.
- If a parent refuses hospitalization or treatment of their child against the best interest of the child, you must get an emergency court order.
- Premature infants
- Children with chronic medical problems
- Infants with colic
- Children with behavioral problems
- Poverty stricken children
- Children of teenage parents
- Single parents
- Children of substance abusers
- Chip fractures (damage to the corner of metaphysis in long bones)
- Spiral fractures
- Rib fractures
- Burns (immersion in hot water, cigarette burns, stocking-glove burns on hands and feet)
- Head injury – MCC of death
- Sexual abuse
When to hospitalize a child under suspect of being abused:
- The hospital is the safest place for the child
- The diagnosis is still unclear
- The child has a medical condition requiring hospitalization
Workup for suspected child abuse:
- Full skeletal survey for breaks
- If injuries are severe, get a CT or MRI + a thorough eye exam
- If injury is to the abdomen, get an abdominal CT, check for blood in the stool and urine, and check liver and pancreatic enzymes
1st – Address medical and/or surgical issues before all else
2nd – Report abuse to child protective services (CPS)