Red Flags for Physical Abuse
- fractures in children < 18 months
- bruises in babies who aren’t yet pulling themselves up to walk (particularly if bruises in non-bony prominences such as sides of cheeks, abdomen)
- delay in presentation
- history that doesn’t match with the injury
- parent blaming child’s sibling for injury
- injuries not appropriate to developmental age of child
- classic patterned injuries such as hand slap imprints, belt-buckle abrasions, or bite marks
- head injuries
Sexual Abuse
To prevent evidence being contaminated:
- speak to parents alone
- ensure child does not hear parents report
- when bring child back into consulting room, do not allow parent to coach child
- if child can ask them to explain what happened in narrative form: ” What did you come to see the doctor for?”
- write down, verbatim, what questions you ask the child