The Mistaken Diagnosis of Child Abuse: A Three-Year USAF Medical Center Analysis and Literature Review

Abstract

Medical personnel who evaluate children for child abuse and neglect (CAN) must be familiar with the many pediatric conditions that resemble CAN in order to avoid over reporting. During a 3-year period, a total of 504 suspected child abuse patients were evaluated by our CAN team. After preliminary evaluation, 264 (52%) of these cases were unsubstantiated. Eighteen of these 264 (7%) were initially considered as cases of CAN but were later proven to be conditions that were misdiagnosed as CAN. Thirteen of the 18 (72%) were readily diagnosed after consultation with a pediatrician or other health care consultant. Investigation of the remaining 5 patients (29%) was more difficult and more extensive, requiring a period of separation from the parents with consequent emotional hardship to the family. These conditions included (1) a patient with osteogenesis imperfecta type IV, (2) a patient with Ehlers-Danlos syndrome, (3) two patients with benign external hydrocephaly of infancy, and (4) a patient with Crohn's disease, who was evaluated for sexual abuse because of chronic abdominal pain. A comprehensive literature review of pediatric conditions that may mimic CAN is presented by diagnostic categories to assist clinicians in differentiating medical conditions that may simulate CAN. Methods to support parents who have been incorrectly reported are discussed.

Victim, perpetrator, family, and incident characteristics of infant and child homicide in the United States Air Force

“…There is a growing amount of research on family violence in the United States military (e.g., Brewster, Nelson, Hymel, Colby, Lucas, McCanne, & Milner, 1998;Merrill, Hervig, & Milner, 1996;Mollerstrom, Patchner, & Milner, 1995;Raiha & Soma, 1997;Rosen & Martin, 1996;Wardinsky, Vizcarrondo, & Cruz, 1995). However, only one of these studies has examined fatal abuse (Brewster et al, 1998).…”

Non-cutaneous conditions clinicians might mistake for abuse

“…They have hinted at the need to be vigilant in looking for mimics in the evaluation of possible abuse cases, but, with the exception of Wardinsky and Wheeler, have not defined the rate among abuse consultations at which these mimics occur 11 12 14. Our study adds to this body of literature by documenting how frequently non-cutaneous mimics with or without associated cutaneous findings are identified among abuse consultations, and by quantifying the proportion of different types of mimics found in a large population of children evaluated for abuse from around the USA.…”

“…While many medical aetiologies have objective tests that can confirm the diagnosis, distinguishing accidental or birth injuries in a population referred for abuse will almost always have some level of subjectivity. Accidental injuries have traditionally been considered as distinct from mimics 11 12 14…”

De last van lenigheid. Kwaliteit van leven bij patiënten met Ehlers-Danlos syndroom

“…Dit laatste kan zich voordoen als een ouder van een kind met EDS zich bij de eerste hulp meldt vanwege luxatie van een gewricht of bloeding bij het kind. Soms wordt de ouder zelfs verdacht van kindermishandeling (Wardinsky, Vizcarrondo & Cruz, 1995), maar ook als die verdenking er niet is, menen sommige ouders toch achterdochtige blikken van hulpverleners te voelen (Berglund et al, 2000). Een ander emotioneel probleem dat uit interviews naar voren komt is verminderde mogelijkheid tot ontplooiing van vaardigheden (Berglund et al, 2000).…”