Child Abuse: The Daily PANCE Blueprint
A 4-year-old boy is brought to the ER by his mother for evaluation of multiple bruises. The mother states that the child “falls often,” but the bruises are in various stages of healing and are located on the face and neck. The child is withdrawn and avoids eye contact. Which of the following is the most appropriate next step in management?
A. Discharge home with reassurance
B. Confront all family members
C. Ensure medical stabilization and safety, then notify Child Protective Services
D. Wait for definitive proof before taking any action
E. Arrange routine outpatient follow-up
Answer and topic summary
The answer is C. Ensure medical stabilization and safety, then notify Child Protective Services
Child abuse is defined as any action by a caretaker/parent that causes harm (physical, emotional, or psychological), sexual abuse, or death of a child. The most common type of child abuse is neglect. Risk factors include alcoholism/drug abuse, unemployment, and personal history of abuse. Clinical features that may be a red flag include STDs, genitourinary complaints, developmental delays, injuries inconsistent with stories, delay in seeking medical treatment, etc. Some high-specificity physical findings for abuse include: bruising patterns (facial bruising, buttock bruising, neck bruising, patterned bruises such as hand slaps), oral injuries (torn frenulum), and subconjunctival hemorrhage. Management should focus first on the child’s safety and medical stabilization. All states mandate reporting of suspected child abuse to Child Protective Services (CPS). The standard is typically “reasonable suspicion” or “reason to believe” – incontrovertible proof is NOT required.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Psychiatry ⇒ ⇒
Also covered as part of the Pediatric EOR topic lists
