Mimics of Non-accidental Injury in Children

  • M-J. Evans


As pathologists, community paediatricians and others involved in the protection of children, we must be cautious not to miss subtle signs of abuse. However, we must also be aware of the many entities that mimic non-accidental injury and thus may arouse suspicion of child abuse. False accusations of abuse can have horrendous social and psychological implications for the families involved. Kirshner and Stein used the term “medical abuse” in order to give some indication as to impact of such a scenario [1]. Conversely, we must not forget that a child suffering from a disease, which simulates abuse, may still be a victim.


Child Abuse Osteogenesis Imperfecta Copper Deficiency Epidermolysis Bullosa Congenital Toxoplasmosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kirschner RH, Stein RJ. The mistaken diagnosis of child abuse. A form of medical abuse? Am J Dis Child 1985;139(9):873–5.PubMedGoogle Scholar
  2. 2.
    Office of National Statistics. Birth specific infant mortality rates for England and Wales, 1996, Table 22,116.Google Scholar
  3. 3.
    Mortality statistics, 1997 series DH3 no.30.Google Scholar
  4. 4.
    Platt MJ. Child health statistics review 1998. Arch Dis Child 1998;79:523–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Egge K, Lyng G, Maltau JM. Retinal haemorrhages in the newborn. Acta Ophthalm 1980;58:231–6.CrossRefGoogle Scholar
  6. 6.
    Ellerstein NS. The cutaneous manifestations of child abuse and neglect. AJDC 1979;133:906–9.PubMedGoogle Scholar
  7. 7.
    Wheeler DM, Hobbs CJ. Mistakes in diagnosing non-accidental injury: 10 years’ experience. BMJ Clin Res Ed. 1988;296(6631):1233–6.CrossRefGoogle Scholar
  8. 8.
    Winship IM, Winship WS. Epidermolysis bullosa misdiagnosed as child abuse. A report of 3 cases. S Afr Med J 1988;73(6):369–70.PubMedGoogle Scholar
  9. 9.
    Adler R, Kane-Nussen B. Erythema multiforme: confusion with child battering syndrome. Pediatrics 1983;72(5):718–20.PubMedGoogle Scholar
  10. 10.
    Brown J, Melinkovich P. Schonlein-Henoch purpura misdiagnosed as suspected child abuse. A case report and literature review. JAMA 1986;256(5):617–8.Google Scholar
  11. 11.
    Levin AV, Selbst SM. Vulvar hemangioma simulating child abuse. Clin Pediat 1988;27(4):213–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Jenny C, Kirby P, Fuquay D. Genital lichen sclerosus mistaken for child sexual abuse. Pediatrics 1989;83(4):597–9.PubMedGoogle Scholar
  13. 13.
    McCann J, Reay D, Siebert J, Stephens BG, Wirtz S. Postmortem perianal findings in children. Am J Forens Med Pathol 1996;17(4):289–98.CrossRefGoogle Scholar
  14. 14.
    O’Hare AE, Eden OB. Bleeding disorders and non-accidental injury. Arch Dis Childhood.1984;59(9):860–4.CrossRefGoogle Scholar
  15. 15.
    Rutty GN, Smith CM, Malia RG. Late-form hemorrhagic disease of the newborn. Am J Forens Med Pathol 1999;20(1):48–51.CrossRefGoogle Scholar
  16. 16.
    Copeland AR. A case of panhypogammaglobulinemia masquerading as child abuse [see comments]. J Forens Sci 1988;33(6):1493–6.Google Scholar
  17. 17.
    Carty H. Brittle or battered. Arch Dis Childhood 1988;63(4):350–2.CrossRefGoogle Scholar
  18. 18.
    Owen SM, Durst RD. Ehlers-Danlos syndrome simulating child abuse. Arch Dermatol 1984;120(1):97–101.PubMedCrossRefGoogle Scholar
  19. 19.
    Shaw JC. Copper deficiency and non-accidental injury. Arch Dis Childhood 1988;63(4):448–55.CrossRefGoogle Scholar
  20. 20.
    Hoffmann GF, Naughten ER. Abuse or metabolic disorder? Arch Dis Childhood 1998;78:399.CrossRefGoogle Scholar
  21. 21.
    Wilkins B. Head injury — abuse or accident? Arch Dis Childhood 1997;76:393–7.CrossRefGoogle Scholar
  22. 22.
    Morris AAM, Hoffmann GF, Naughten ER, Monovari AA, Collins JE, Leonard JV. Glutaric aciduria and suspected child abuse 1999:80:404–5.Google Scholar
  23. 23.
    Fiser RH, Kaplan J, Holder JC. Congenital syphilis mimicking the battered child syndrome. How does one tell them apart? Clin Pediat 1972;ll(5):305–7.CrossRefGoogle Scholar
  24. 24.
    Horodniceanu C, Grunebaum M, Volovitz B, Nitzan M. Unusual bone involvement in congenital syphilis mimicking the battered child syndrome. Pediat Radiol 1978;7(4):232–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Asnes RS, Wisotsky DH. Cupping lesions simulating child abuse. J Pediat 1981;99(2):267–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Reinhart MA, Ruhs H. Moxibustion. Another traumatic folk remedy. Clin Pediat 1985;(1):58–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Yeatman GW, Dang VV. Cao Gio (coin rubbing). Vietnamese attitudes toward health care. JAMA 1980;244(24):2748–9.Google Scholar
  28. 28.
    Guarnaschelli J, Lee J, Pitts FW. “Fallen fontanelle” (caida de Mollera). A variant of the battered child syndrome. JAMA 1972;222(12):1545–6.Google Scholar
  29. 29.
    Schmitt BD, Gray JD, Britton HL. Car seat burns in infants: avoiding confusion with inflicted burns. Pediatrics 1978;62(4):607–9.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2001

Authors and Affiliations

  • M-J. Evans

There are no affiliations available

Personalised recommendations