Evaluation of Physical Abuse and Neglect

  • Sheela L. LahotiEmail author
  • Rebecca G. Girardet
  • Angelo P. Giardino


It may be difficult to identify children who are victims of physical abuse. Many injuries are not pathognomonic, and the diagnosis may not be obvious. The history given by the caregiver may be misleading or incomplete, causing a delay or mistake in diagnosis. In addition, victims of abuse often are too young to provide a history. Although only a small percentage of injuries seen by healthcare professionals are the result of abuse, there are a number of historical and physical findings that should raise the suspicion of nonaccidental trauma.

Diagnosing child abuse requires knowledge of child development, the epidemiology of trauma, mechanisms of injury in children, and the differential diagnosis of various forms of injury. The medical evaluation includes a history, physical examination, indicated laboratory and diagnostic studies, and observation of the caregiver–child interaction. Careful attention to the possibility of child maltreatment in the differential diagnosis generated when evaluating children for injuries is essential. There is a growing body of evidence highlighting the devastating consequences of cases in which an initial evaluation fails to diagnose abuse only to present again for care later with additional injuries. These later injuries could have been prevented had the child been accurately diagnosed as having been maltreated when they first presented on the initial or previous evaluations. Completing a detailed history and physical examination is paramount because many cases of abuse are first detected by identifying discrepancies between the history and physical findings. It is ideal for two individuals, such as a physician and nurse or social worker, to obtain a history together. The likelihood that important questions will be missed decreases if more than one person is present to interview the family. In addition, information can be recorded by one person, while the other asks questions. After the interview, the questioners can review information for accuracy.


Medical evaluation Documentation Physical exam Medical history Interview process 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sheela L. Lahoti
    • 1
    Email author
  • Rebecca G. Girardet
    • 1
  • Angelo P. Giardino
    • 2
  1. 1.Department of PediatricsMcGovern Medical School at The University of Texas Health Science Center at HoustonHoustonUSA
  2. 2.Department of PediatricsUniversity of Utah HealthSalt Lake CityUSA

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