eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Child Abuse & Neglect, Physical Abuse: Treatment & Medication

Author: Angelo P Giardino, MD, PhD, Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc
Coauthor(s): Eileen R Giardino, PhD, RN, MSN, FNP-BC, ANP-BC, Associate Professor of Nursing, Department of Acute and Continuing Care, University of Texas Health Sciences Center Houston School of Nursing
Contributor Information and Disclosures

Updated: Dec 12, 2008

Treatment

Medical Care

Treatment for physical abuse is a complex endeavor involving an interdisciplinary team approach. The nature of the injury determines the form of medical therapy, and the details of the caregiving environment determine the psychosocial supports needed to keep the child safe.

  • For medical issues, skeletal fractures of the long bones may require casting, and orthopedics should be consulted for assistance with diagnosis and management.
  • If clinical consideration is being given to the possibility of osteogenesis imperfecta (OI), a genetics consultation may also be valuable.
  • Burns vary in severity and treatments range from cleansing the area to skin grafting.
  • The most severely injured children, such as those with CNS injury, may require resuscitation and will need intensive care.
    • A multitude of specialists may need to be involved in order to correctly evaluate and treat these seriously ill children.
    • Whenever shaken baby syndrome is suspected, ophthalmology should be consulted for a formal evaluation, including examination of the eyes for retinal hemorrhages.
  • Psychosocial management that requires a significant amount of coordination among various services providers, including the physician and other health care providers, complements the medical management. Child protective services (CPS) agency in each community is responsible for performing investigations of cases in which physical abuse is suspected and relies on the physician to provide the details of the medical evaluation. In addition, CPS assesses the caregivers' background, caregiving abilities and potential, environmental safety, risk for repeat abuse, and risk to other siblings. A variety of treatment options are available, ranging from periodic contact with the child and family to removal of the child from the home, either temporarily or permanently, with termination of parental rights. The CPS process for child maltreatment cases typically involves the following steps:
    • Intake - Screening of reports and acceptance of case
    • Initial risk assessment - Caregiver interviews, medical information gathering, home evaluation, and possibility of contact with law enforcement
    • Case planning - Determination of safety for the child with essentially 3 options: (1) the child goes home with the caregiver with or without services depending on the circumstances, (2) the child is removed from home and family with caregivers consent and offered services to assist them in working towards reunifying with the child, and (3) the child is removed from the home and family without caregiver's consent, involving court action and incorporation of legal steps and processes to determine the ultimate plan for the child.

Consultations

  • Pediatric radiologist - If dating of bone injuries become central to the maltreatment investigation
  • Orthopedics - For assistance with diagnosis and management in cases of skeletal fractures of the long bones
  • Genetics - For detailed workup for OI and the characterization of the collagen disorder
  • Plastic surgery - For assistance with management of serious burns
  • Ophthalmology - Whenever abusive head trauma (AHT)/shaken baby syndrome (SBS) is suspected, for a formal evaluation including examination of the eyes for retinal hemorrhages
  • Child psychiatrist, behavioral-developmental pediatrician, or psychiatric social worker to assess the mental health needs of child and family as well as coordinate overall psychosocial treatment plan

More on Child Abuse & Neglect, Physical Abuse

Overview: Child Abuse & Neglect, Physical Abuse
Differential Diagnoses & Workup: Child Abuse & Neglect, Physical Abuse
Treatment & Medication: Child Abuse & Neglect, Physical Abuse
Follow-up: Child Abuse & Neglect, Physical Abuse
Multimedia: Child Abuse & Neglect, Physical Abuse
References
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References

  1. Sedlak AJ, Broadhurst DD. Third National Incidence Study of Child Abuse and Neglect (NIS-3 Final Report). US Dept of Health and Human Services;1996. Contract No. 105-94-1840.

  2. National Center on Child Abuse and Neglect. National Child Abuse and Neglect Data System: 1991 Summary Data Component. Washington, DC: Government Printing Office;1993. Working Paper 2.

  3. Helfer RE. The developmental basis of child abuse and neglect: An epidemiological approach. In: The Battered Child. 4th ed. Chicago, IL: University of Chicago Press; 1987:60-80.

  4. Straus MA, Kantor GK. Corporal punishment of adolescents by parents: a risk factor in the epidemiology of depression, suicide, alcohol abuse, child abuse, and wife beating. Adolescence. Fall 1994;29(115):543-61. [Medline].

  5. American Academy of Pediatrics Web site. Periodic Survey of Fellows #38: Attitudes and Counseling on Corporal Punishment in the Home: July 1998. Available at: www.aap.org/research/ps38exs1.htm. Accessed 2000.

  6. Administration for Children and Families. US Department of Health and Human Services NIS-4 Description. [Full Text].

  7. Finkelhor D, Jones L. Updated Trends in Child Maltreatment 2006. Crimes Against Children Research Center. University of New Hampshire. Available at http://cyber.law.harvard.edu/sites/cyber.law.harvard.edu/files/Trends%20in%20Child%20Maltreatment.pdf. Accessed December 2, 2008.

  8. Prevent Child Abuse America. 2006 National Child Maltreatment Statistics National Center on Child Abuse Prevention Research. US Department of Health and Human Services, Administration on Children, Youth ad Families. Available at http://member.preventchildabuse.org/site/DocServer/Child_Maltreatment_Fact_Sheet_2005.pdf?docID=221. Accessed November 25, 2008.

  9. DiScala C, Sege R, Li G, Reece RM. Child Abuse and Unintentional Injuries. Pediatr Adolesc Med. 2001;154:16-22.

  10. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. May 1998;14(4):245-58. [Medline].

  11. Adverse Childhood Experiences (ACE) Study. Center for Disease Control. Available at http://www.cdc.gov/NCCDPHP/ACE/PYRAMID.HTM. Accessed December 2, 2008.

  12. American Humane Association. AHA fact sheet #12: The use of physical discipline. Englewood, CO;1994.

  13. Bays J. Reece RM, Ludwig S, eds. Child Abuse: Medical Diagnosis and Management. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:287-306.

  14. Bays J, Jenny C. Genital and anal conditions confused with child sexual abuse trauma. Am J Dis Child. Dec 1990;144(12):1319-22. [Medline].

  15. Belsky J. Child maltreatment: an ecological integration. Am Psychol. Apr 1980;35(4):320-35. [Medline].

  16. Berkowitz CD. Pediatric abuse. New patterns of injury. Emerg Med Clin North Am. May 1995;13(2):321-41. [Medline].

  17. Bronfenbrenner U. Toward an experimental ecology of human development. Am Psychol. 1977;32:513-31.

  18. Child Maltreatment 2003. US Department of Health and Human Services. Available at http://www.acf.hhs.gov/programs/cb/pubs/cm03/cm2003.pdf.

  19. Giardino, AP, Alexander R, eds. Child Maltreatment: A Clinical Guide and Reference. 3rd ed. St. Louis, MO: GW Medical Publications; 2005.

  20. Clark KD, Tepper D, Jenny C. Effect of a screening profile on the diagnosis of nonaccidental burns in children. Pediatr Emerg Care. Aug 1997;13(4):259-61. [Medline].

  21. Coant PN, Kornberg AE, Brody AS, Edwards-Holmes K. Markers for occult liver injury in cases of physical abuse in children. Pediatrics. Feb 1992;89(2):274-8. [Medline].

  22. Dubowitz H. Prevention. In: Child Maltreatment: A Clinical Guide & Reference. St. Louis, MO: GW Medical Publishing Inc; 2005:1063-90.

  23. Duhaime AC, Christian CW, Rorke LB, Zimmerman RA. Nonaccidental head injury in infants--the "shaken-baby syndrome". N Engl J Med. Jun 18 1998;338(25):1822-9. [Medline].

  24. Feldman KW. Evaluation of Physical Abuse. In: Helfer ME, Kempe RS, Krugman RD, eds. The Battered Child. 5th ed. Chicago, IL: The University of Chicago Press; 1997:175-220.

  25. Garbarino J. The human ecology of child maltreatment: A conceptual model for research. Journal of Marriage and the Family. 1977;39:721-727.

  26. Garbarino J, Brookhouser PE, Authier KJ. Special Children Special Risks: The Maltreatment of Children with Disabilities. New York, NY: Aldine deGruyter; 1987.

  27. Garbarino J, Eckenrode J. Understanding Abusive Families: An Ecological Approach to Theory and Practice. San Francisco, CA: Jossey-Bass Publishers; 1997.

  28. Giardino AP, Alexander R. Child Maltreatment: A Clinical Guide and Reference. 3rd ed. St Louis, MO: GW Medical Publishing, Inc; 2005.

  29. Giardino AP, Christian CW, Giardino ER. A Practical Guide to the Evaluation of Child Physical Abuse and Neglect. California: Sage Publications Inc; 1997.

  30. Giardino AP, Giardino ER. Recognition of Child Abuse for the Mandated Reporter. St. Louis, MO: GW Medical Publishing Inc; 2002.

  31. Graham-Bermann SA, Edleson JL. Domestic Violence in the Lives of Children: The Future of Research, Intervention. Washington, DC: American Psychological Association; 2001.

  32. Grossman DC, Rauh MJ, Rivara FP. Prevalence of corporal punishment among students in Washington State schools. Arch Pediatr Adolesc Med. May 1995;149(5):529-32. [Medline].

  33. Gushurst CA. Child abuse: behavioral aspects and other associated problems. Pediatr Clin North Am. Aug 2003;50(4):919-38. [Medline].

  34. Hansbrough JF, Hansbrough W. Pediatric burns. Pediatr Rev. Apr 1999;20(4):117-23; quiz 124. [Medline].

  35. Harding B, Ridson RA, Krous HF. Shaken Baby Syndrome. BMJ. 2004;328:720-921.

  36. Helfer RE. The etiology of child abuse. Pediatrics. Apr 1973;51:Suppl 4:777-9. [Medline].

  37. Hyman IA. The Case Against Spanking: How to Discipline Your Child Without Hitting. San Francisco, CA: Jossey-Bass Publishers; 1997.

  38. In Harm's Way: Domestic Violence and Child Maltreatment. 1998. Washington, DC: U.S. Department of Health and Human Services. Children's Bureau, Administration on Children, Youth Families. Administration for Children and Families. National Clearing House on Child Abuse and Neglect Information; 1998. 2. [Full Text].

  39. Jenny C. Cutaneous manifestations of abuse. Child Abuse: Medical Diagnosis and Management. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:23-45.

  40. Johnson CF. Inflicted injury versus accidental injury. Pediatr Clin North Am. Aug 1990;37(4):791-814. [Medline].

  41. Knapp JF, Dowd MD. Family violence: implications for the pediatrician. Pediatr Rev. Sep 1998;19(9):316-21. [Medline].

  42. Lazoritz S, Baldwin S, Kini N. The Whiplash Shaken Infant Syndrome: has Caffey's syndrome changed or have we changed his syndrome?. Child Abuse Negl. Oct 1997;21(10):1009-14. [Medline].

  43. Levin AV. Ocular manifestations of child abuse. In: Child Abuse: Medical Diagnosis and Management. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:97-107.

  44. Ludwig S. Child abuse. In: Textbook of Pediatric Emergency Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000:1669-1704.

  45. McCormick KF. Attitudes of primary care physicians toward corporal punishment. JAMA. Jun 17 1992;267(23):3161-5. [Medline].

  46. Myers JEB. Expert testimony. In: The APSAC Handbook on Child Maltreatment. 1996:319-40.

  47. Reece RM, Nicholson CE. Inflicted Childhood Neurotrauma. Elk Grove Village, IL: American Academy of Pediatrics; 2003.

  48. Reece RM, Sege R. Childhood head injuries: accidental or inflicted?. Arch Pediatr Adolesc Med. Jan 2000;154(1):11-5. [Medline].

  49. Robson MC, Heggers JP. Pathophysiology of the burn wound. In: Carvajal HF, Parks DH, eds. Burns in Children: Pediatric Burn Management. Chicago, IL: Year Book; 1988:27-32.

  50. Schene PA. Past, present, and future roles of child protective services. Future Child. Spring 1998;8(1):23-38. [Medline].

  51. Schwartz AJ, Ricci LR. How accurately can bruises be aged in abused children? Literature review and synthesis. Pediatrics. Feb 1996;97(2):254-7. [Medline].

  52. Sirotnak AP, Krugman RD. Physical abuse of children: an update. Pediatr Rev. Oct 1994;15(10):394-9. [Medline].

  53. Spivak BS. Biomechanics of nonaccidental trauma. In: Ludwig S, Kornberg AE, eds. Child Abuse: A Medical Reference. 2nd ed. New York, NY: Churchill Livingstone; 1992:61-78.

  54. Stein MT, Perrin EL. Guidance for effective discipline. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health. Pediatrics. Apr 1998;101(4 Pt 1):723-8. [Medline].

  55. Straus MA. Is violence toward children increasing? A comparison of 1975 and 1985 national survey rates. In: Family Violence. 2nd ed. Newbury Park, CA: Sage; 1987:78-88.

  56. Torrey SB, Ludwig S. The emergency physician in the courtroom: serving as an expert witness in cases of child abuse. Pediatr Emerg Care. Mar 1987;3(1):50-2. [Medline].

  57. Weston WL, Lane AT, Morelli JG. Color Textbook of Pediatric Dermatology. 2nd ed. St Louis, MO: Mosby; 1996.

  58. Wolraich ML, Aceves J, Feldman HM, et al. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health. The child in court: a subject review. Pediatrics. Nov 1999;104(5 Pt 1):1145-8. [Medline].

  59. World Report on Violence and Health. World Health Organization. Available at http://www.who.int/violence_injury_prevention/violence/world_report/en/full_en.pdf. Accessed December 2, 2008.

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Further Reading

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Keywords

physical abuse, child maltreatment, child abuse, victimization, physical maltreatment, intentional injury, nonaccidental injury, inflicted injury, fracture, burn, bruise, subdural hematoma, SDH, abusive head trauma, AHT, shaken baby syndrome, SBS, shaking-impact syndrome, maltreatment, domestic violence, corporal punishment, fractures, whiplash syndrome, smoking, severe obesity, physical inactivity, depressed mood, suicide attempts, alcoholism, drug abuse, ischemic heart disease, cancer, stroke, chronic bronchitis, emphysema, diabetes, hepatitis, skeletal fractures

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Contributor Information and Disclosures

Author

Angelo P Giardino, MD, PhD, Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc
Angelo P Giardino, MD, PhD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect
Disclosure: Nothing to disclose.

Coauthor(s)

Eileen R Giardino, PhD, RN, MSN, FNP-BC, ANP-BC, Associate Professor of Nursing, Department of Acute and Continuing Care, University of Texas Health Sciences Center Houston School of Nursing
Eileen R Giardino, PhD, RN, MSN, FNP-BC, ANP-BC is a member of the following medical societies: American Academy of Nurse Practitioners, American College Health Association, American Nurses Association, American Professional Society on the Abuse of Children, and International Society for Prevention of Child Abuse and Neglect
Disclosure: Nothing to disclose.

Medical Editor

Chet Johnson, MD, Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center
Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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