Skin Injury Concerning for Physical Abuse
| Additional Resource with Photos: VisualDx/Bruise of child abuse |
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Bruising anywhere on a non-ambulatory infant |
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Subconjunctival injury in infants (not due to birth) |
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Torn frenulum or oral injury in a non-ambulatory infant |
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Bruising located in TEN-FACES regions on any child
Bruising to the buttocks or genitals |
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Patterned bruising
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Burns on a non-ambulatory infant |
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Patterned burns (imprint of object) with insufficient mechanism |
References
Petska, H. W., & Sheets, L. K. (2014). Sentinel injuries: Subtle findings of physical abuse. Pediatric Clinics of North America, 61, 923-935. https://dx.doi.org/10.1016/j.pcl.2014.06.007
Pierce, M. C., Kaczor, K., Lorenz, D. J., Bertocci, G., Fingarson, A. K., Makoroff, K., Berger, R. P., Bennett, B., Magana, J., Staley, S., Ramaiah, V., Fortin, K., Currie, M., Herman, B. E., Herr, S., Hymel, K. P., Jenny, C., Sheehan, K., Zuckerman, N.,...Leventhal, J. M. (2021). Validation of a clinical decision rule to predict abuse in young children based on bruising characteristics. Journal of the American Medical Association, 4(4), e215832. https://doi.org/10.1001/jamanetworkopen.2021.5832
Sugar, N. F., Taylor, J. A., & Feldman, K. W. (1999). Bruises in infants and toddlers: Those who don't cruise rarely bruise. Archives of Pediatric and Adolescent Medicine, 153(4), 399-403. https://doi.org/10.1001/archpedi.153.4.399
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.