Child Abuse Follow-up

Updated: Jul 24, 2018
  • Author: Julia Magana, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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Follow-up

Further Outpatient Care

In addition to the medical follow-up needs (eg, orthopedic, surgical, neurological) of the abused child, these children often need follow up with a child abuse specialist, forensic interviewer, and mental health follow-up. The recommended follow-up should be clearly documented. This is important since a child may be placed in another environment and a foster parent or CPS worker will be responsible for seeing that the child receives indicated medical follow-up care/consultation.

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Further Inpatient Care

In some hospital settings, the child suspected of having been abused may be hospitalized if safety cannot otherwise be guaranteed. This course of action has several advantages. The severity of the injuries need not be the sole determining factor for hospitalization. Hospitalization may offer time to sort out difficult diagnostic (whether the injury is inflicted or accidental) and therapeutic (whether the child is safe at home) decisions.

When utilization policy does not permit admission for safety only, Child Protective Services (CPS) may place the child in a safe alternate shelter or foster home.

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Transfer

Depending on the complexity of pediatric subspecialty services needed, the clinician should consider transferring the child to a tertiary care children’s hospital with a multidisciplinary team that is experienced in the evaluation and management of child abuse.

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Deterrence/Prevention

Young victims who were seen with injuries that were documented but not referred to CPS or were referred and returned to the family can be reinjured, some with fatal outcomes. [1, 2, 3, 19, 20, 29] Appropriate suspicion, documentation, and referral are the best ways an emergency department (ED) provider can prevent child abuse.

Prevention programs, such as the Nurse-Family Partnership, EarlyStart, and Triple P programs; parenting classes; and home health services are available in many communities and target high-risk families. Local social workers can refer the family towards these supportive, preventative resources.

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Complications

Physical injuries can leave permanent scars that disfigure the child and act as a constant reminder of trauma.

Child maltreatment exposure is potentially the single greatest risk factor in the development of mental illness.

Severe long-term complications may result from damage to organs or organ systems. This is especially true of traumatic brain injury that can lead to seizures, mental retardation, or cerebral palsy.

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Prognosis

Without appropriate social service and mental health intervention, child abuse can be a recurrent and escalating problem.

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Patient Education

Parents can be educated about appropriate discipline techniques, including discouraging the use of physical discipline, particularly in high-risk families.

Parents should be educated about the dangers of shaking infants, especially when the child presents with a chief complaint of fussiness.

For patient education resources, visit eMedicineHealth's Children's Health Center. Also, see eMedicineHealth's patient education articles Child Abuse, Bruises, and Black Eye.

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