Recent Skin Injuries in Normal Children

Labbé, Jean; Caouette, Georges

doi:10.1542/peds.108.2.271

Cited by 99 publications

(82 citation statements)

References 15 publications

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“…75 There is ample evidence that evaluating bruising patterns in abused and nonabused children helps to identify specific ages, locations, and patterns of bruising that are highly correlated with child abuse. [76][77][78][79][80][81] In children with bruising related to normal activity, the prevalence and mean number of bruises increases with age, and the majority of preschool-aged and schoolchildren have accidental bruises. 82 The commonest sites of bruising in nonabused, ambulatory children are to the knees and shins, and the vast majority of normal bruises are over bony prominences, including the forehead.…”

Section: Skin Injuriesmentioning

confidence: 99%

The Evaluation of Suspected Child Physical Abuse

Christian¹

2015

Pediatrics

463

301

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Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children.

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Section: Skin Injuriesmentioning

confidence: 99%

The Evaluation of Suspected Child Physical Abuse

Christian¹

2015

Pediatrics

463

301

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“…39 Inflicted trauma may be suspected when injuries are noted in protected areas of the body (torso, genitals, neck, medial thighs), 40 when they have a patterned appearance, or when the explanation provided by the patient is incongruous with the injury. 39 Laboratory testing and diagnostic imaging for possible internal injury may be indicated.…”

Section: Victim Identification and Evaluationmentioning

confidence: 99%

Child Sex Trafficking and Commercial Sexual Exploitation: Health Care Needs of Victims

Greenbaum¹,

Crawford-Jakubiak²,

Neglect³

2015

Pediatrics

216

160

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Child sex trafficking and commercial sexual exploitation of children (CSEC) are major public health problems in the United States and throughout the world. Despite large numbers of American and foreign youth affected and a plethora of serious physical and mental health problems associated with CSEC, there is limited information available to pediatricians regarding the nature and scope of human trafficking and how pediatricians and other health care providers may help protect children. Knowledge of risk factors, recruitment practices, possible indicators of CSEC, and common medical and behavioral health problems experienced by victims will help pediatricians recognize potential victims and respond appropriately. As health care providers, educators, and leaders in child advocacy, pediatricians play an essential role in addressing the public health issues faced by child victims of CSEC. Their roles can include working to increase recognition of CSEC, providing direct care and anticipatory guidance related to CSEC, engaging in collaborative efforts with medical and nonmedical colleagues to provide for the complex needs of youth, and educating child-serving professionals and the public.

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“…8 Identifying which children with bruising warrant an evaluation for abuse and SS can be challenging, especially in mobile older infants and toddlers who frequently experience accidental bruising. 14,15 Several studies have identified characteristics of bruises associated with abusive versus accidental injury, but clear guidelines for clinicians regarding when to perform an initial SS for abuse in young children with bruising have not been developed. 1,16 Accordingly, the goal of this study was to develop guidelines for performing initial SS in children ,2 years old presenting with bruising.…”

Section: What This Study Addsmentioning

confidence: 99%

Development of Hospital-Based Guidelines for Skeletal Survey in Young Children With Bruises

2015

PEDIATRICS

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OBJECTIVE: To develop guidelines for performing an initial skeletal survey (SS) for children ,24 months of age presenting with bruising in the hospital setting, combining available evidence with expert opinion. METHODS:Applying the Rand/UCLA Appropriateness Method, a multispecialty panel of 10 experts relied on evidence from the literature and their own clinical expertise in rating the appropriateness of performing SS for 198 clinical scenarios characterizing children ,24 months old with bruising. After a moderated discussion of initial ratings, the scenarios were revised. Panelists re-rated SS appropriateness for 219 revised scenarios. For the 136 clinical scenarios in which SS was deemed appropriate, the panel finally assessed the necessity of SS.RESULTS: Panelists agreed that SS is "appropriate" for 62% (136/219) of scenarios, and "inappropriate" for children $12 months old with nonpatterned bruising on bony prominences. Panelists agreed that SS is "necessary" for 95% (129/136) of the appropriate scenarios. SS was deemed necessary for infants ,6 months old regardless of bruise location, with rare exceptions, but the necessity of SS in older children depends on bruise location. According to the panelists, bruising on the cheek, eye area, ear, neck, upper arm, upper leg, hand, foot, torso, buttock, or genital area necessitates SS in children ,12 months. CONCLUSIONS:The appropriateness and necessity of SS in children presenting for care to the hospital setting with bruising, as determined by a diverse panel of experts, depends on age of the child and location of bruising. WHAT'S KNOWN ON THIS SUBJECT:Bruising is common in young victims of physical abuse as well as in cases of accidental trauma. There is uncertainty regarding which young children with bruising require evaluation with skeletal survey for possible abuse. WHAT THIS STUDY ADDS:The results of this study provide guidelines, based on the literature and knowledge of experts, for identifying children ,24 months presenting for care in the hospital setting with bruises, who should and should not undergo skeletal survey.

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Recent Skin Injuries in Normal Children

Cited by 99 publications

References 15 publications

The Evaluation of Suspected Child Physical Abuse

The Evaluation of Suspected Child Physical Abuse

Child Sex Trafficking and Commercial Sexual Exploitation: Health Care Needs of Victims

Development of Hospital-Based Guidelines for Skeletal Survey in Young Children With Bruises

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