Advertisement

Abuse and Factitious Disorders

  • Kirsten Simonton
  • Kara N. ShahEmail author
Chapter
  • 891 Downloads

Abstract

Recognizing the cutaneous manifestations of child abuse, including physical and sexual abuse, is an important component of the medical evaluation in both the hospital-based and outpatient setting. Subtle clues on the skin examination may indicate the need for further evaluation, and the provider needs to be able to distinguish the features of injuries suspicious for non-accidental trauma from accidental skin injuries, medical conditions such as vasculitis, and skin signs of cultural practices such as cupping. Clinicians should also be able to recognize the signs of child neglect, in particular in high-risk situations or in cases where child abuse is also suspected. With regard to anogenital skin findings, sexual abuse should be considered when the lesions present indicate trauma. Finally, the possibility of self-induced skin lesions should always be considered when the history and/or examination is not consistent with a defined skin disorder.

Keywords

Child physical abuse Child sexual abuse Child neglect Ecchymoses Thermal burn Factitious disorder Pathological skin picking 

References

  1. 1.
    Christian CW, Committee on Child A, Neglect AAoP. The evaluation of suspected child physical abuse. Pediatrics. 2015;135(5):e1337–54.CrossRefPubMedGoogle Scholar
  2. 2.
    Anderst JD, Carpenter SL, Abshire TC, Section on HO, Committee on Child A, Neglect of the American Academy of P. Evaluation for bleeding disorders in suspected child abuse. Pediatrics. 2013;131(4):e1314–22.CrossRefPubMedGoogle Scholar
  3. 3.
    Harper NS, Feldman KW, Sugar NF, Anderst JD, Lindberg DM, Examining Siblings To Recognize Abuse I. Additional injuries in young infants with concern for abuse and apparently isolated bruises. J Pediatr. 2014;165(2):383–8 e1.CrossRefPubMedGoogle Scholar
  4. 4.
    Lindberg DM, Berger RP, Reynolds MS, Alwan RM, Harper NS, Examining Siblings To Recognize Abuse I. Yield of skeletal survey by age in children referred to abuse specialists. J Pediatr. 2014;164(6):1268–73 e1.CrossRefPubMedGoogle Scholar
  5. 5.
    Kellogg N, American Academy of Pediatrics Committee on Child A, Neglect. The evaluation of sexual abuse in children. Pediatrics. 2005;116(2):506–12.CrossRefPubMedGoogle Scholar
  6. 6.
    Girardet RG, Lahoti S, Howard LA, Fajman NN, Sawyer MK, Driebe EM, et al. Epidemiology of sexually transmitted infections in suspected child victims of sexual assault. Pediatrics. 2009;124(1):79–86.CrossRefPubMedGoogle Scholar
  7. 7.
    Jenny C, Crawford-Jakubiak JE, Committee on Child A, Neglect, American Academy of P. The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics. 2013;132(2):e558–67.CrossRefPubMedGoogle Scholar
  8. 8.
    Faller-Marquardt M, Pollak S, Schmidt U. Cigarette burns in forensic medicine. Forensic Sci Int. 2008;176(2–3):200–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Chester DL, Jose RM, Aldlyami E, King H, Moiemen NS. Non-accidental burns in children—are we neglecting neglect? Burns. 2006;32(2):222–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Kemp AM, Maguire SA, Lumb RC, Harris SM, Mann MK. Contact, cigarette and flame burns in physical abuse: a systematic review. Child Abuse Rev. 2014;23(1):35–47.CrossRefGoogle Scholar
  11. 11.
    Degraw M, Hicks RA, Lindberg D, Using Liver Transaminases to Recognize Abuse Study I. Incidence of fractures among children with burns with concern regarding abuse. Pediatrics. 2010;125(2):e295–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Gieler U, Consoli SG, Tomas-Aragones L, Linder DM, Jemec GB, Poot F, et al. Self-inflicted lesions in dermatology: terminology and classification—a position paper from the European Society for Dermatology and Psychiatry (ESDaP). Acta Derm Venereol. 2013;93(1):4–12.PubMedGoogle Scholar
  13. 13.
    Shah KN, Fried RG. Factitial dermatoses in children. Curr Opin Pediatr. 2006;18(4):403–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Chiriac A, Brzezinski P, Pinteala T, Chiriac AE, Foia L. Common psychocutaneous disorders in children. Neuropsychiatr Dis Treat. 2015;11:333–7.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Mayerson Center for Safe and Healthy Children, Cincinnati Children’s HospitalCincinnatiUSA
  2. 2.Division of DermatologyCincinnati Children’s HospitalCincinnatiUSA

Personalised recommendations