Researchers urge routine screening for child abuse

(HealthDay)—The early signs of child abuse among infants and toddlers—head trauma, rib fractures, or abdominal injuries—are often missed, and that may be due in part to a lack of standardized screening, researchers report. The findings were published online Oct. 5 in Pediatrics.

Daniel Lindberg, M.D., from the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect in Denver, and colleagues examined the records of more than 4.1 million children under the age of 2 who had been seen at one of 18 different medical institutions during a seven-year period. From these records, the researchers identified 30,355 children who had sentinel injuries. The researchers excluded children who had been in a car accident or had been previously diagnosed with child abuse. Most of these children—90 percent—had only one potentially suspicious injury.

Among all the children under 2 years of age, 0.17 percent had been victims of child abuse, but percentages were higher among those with sentinel injuries. For example, 3.5 percent of children under 1 year old with burns and 56 percent of children under 2 years old with rib fractures had been abused. Among those with rib fracture, severe abdominal injury or intracranial hemorrhage, at least one in five children had been abused, according to the researchers.

Medical test usage for identifying abuse varied greatly across hospitals, the investigators found. For example, anywhere from 20 to 74 percent of the children received skeletal surveys, depending on the center. "For the most concerning injuries in this study, the risk of abuse is high enough, the risk of missing that abuse is high enough, and the risks of testing small enough, that testing should be routine," Lindberg told HealthDay.