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Evaluation of Physical Abuse and Neglect

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A Practical Guide to the Evaluation of Child Physical Abuse and Neglect

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Abstract

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 (Kellogg et al., 2007). 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 health care professionals are the result of abuse, there are a number of historical and physical findings that should raise the suspicion of nonaccidental trauma.

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Author information

Authors and Affiliations

  1. University of Texas Medical School–Houston, Houston, Texas, USA

    Rebecca G. Girardet MD

  2. Baylor College of Medicine, Texas Children’s Health Plan, Inc., Suite 34L, Houston, Texas, 77021, USA

    Angelo P. Giardino MD, PhD, MPH

Authors
  1. Rebecca G. Girardet MD
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  2. Angelo P. Giardino MD, PhD, MPH
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Editor information

Editors and Affiliations

  1. Texas Children's Health Plan, Inc., Holcombe Blvd. 2450, Houston, 77021, Texas, USA

    Angelo P. Giardino

  2. Texas Children’s Hospital, Children's Assessment Center, Baylor College of Medicine, Fannin St. 6621, Houston, 77030-2399, Texas, USA

    Michelle A. Lyn

  3. School of Nursing at Houston, Department of Integrative Care, University of Texas, Bertner 6901, Houston, 77030, Texas, USA

    Eileen R. Giardino

Appendix

Appendix

Series 1: Series of photos showing bruising on a child’s thighs. Please take not of the various angles and different distance of the photos and the ruler placement.

Photo 1a
figure c

Photo of bruising on a child’s left thigh.

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Photo 1b
figure d

Photo of bruising on child’s lower thigh from a different perspective.

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Photo 1c
figure e

Photo from a different angle and distance.

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Photo 1d
figure f

Photo of same child with bruising of right thigh.

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Series 2: Child with horizontal bruise and overlying abrasion of left cheek. Notice the various angles and distance of the photos that enhance the description of the injuries.

Photo 2a
figure g

Photo of the child with horizontal bruise and overlying abrasion of left cheek

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Photo 2b
figure h

Photo taken straight on of the child with horizontal bruise and overlying abrasion of left cheek.

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Photo 2c
figure i

Photo of patient in 2b at a closer distance.

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Photo 2d
figure j

Photo Same patient as in previous image with a similar patterned injury on the right side of the face.

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Series 3: Suprapubic and penile bruising.

Photo 3a
figure k

Photo taken at a distance of suprapubic and penile bruising.

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Photo 3b
figure l

Photo of patient in 3a at a closer distance.

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Photo 3c
figure m

Photo of patient in 3a, with examiner positioning penis to further demonstrate bruise on tip of penis.

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Series 4: Photo documentation of injury to left thigh. Notice the varying distances at which the photos were taken.

Photo 4a
figure n

Photo of injury to left thigh. Notice the placement of the ruler with the identification of the side of the body.

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Photo 4b
figure o

Closer view of the injury to left thigh.

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Photo 4c
figure p

Close up view of the injury to left thigh.

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Photo 4d
figure q

Close up view of the injury to left thigh.

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Series 5: Photo documentation of injured shoulders. Notice identification of body part along with ruler placement.

Photo 5a
figure 12

Photo of right shoulder injury.

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Photo 5b
figure r

Photo of right shoulder injury taken at a different angle.

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Photo 5c
figure s

Photo of left shoulder injury.

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Series 6: Adolescent female with multiple bruise on the neck. Notice the different angles from which the photos are taken

Photo 6a
figure t

Frontal view of the bruising on the neck.

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Photo 6b
figure u

Close up of the burising on the neck.

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Photo 6c
figure v

Photo of the right side of the bruising on the neck.

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Photo 6d
figure w

Photo of the left side of the bruising on the neck.

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Series 7: Photo documentation of locations of injuries with ruler

Photo 7a
figure x

Photo of injury on left side of the neck.

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Photo 7b
figure y

Closer view of the patient in photo 7a

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Photo 7c
figure z

Close up of the injury to patient in photo 7a on the right side of the neck.

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Girardet, R.G., Giardino, A.P. (2010). Evaluation of Physical Abuse and Neglect. In: Giardino, A., Lyn, M., Giardino, E. (eds) A Practical Guide to the Evaluation of Child Physical Abuse and Neglect. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0702-8_2

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  • DOI: https://doi.org/10.1007/978-1-4419-0702-8_2

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