Cutaneous manifestations of child abuse and neglect: Part I - 19/08/22

Doi : 10.1016/j.jaad.2021.11.067

Kathryn Bentivegna, MPH ^a, Jane M. Grant-Kels, MD ^b,^c,^⁎ , Nina Livingston, MD ^d
^a University of Connecticut School of Medicine, Farmington, Connecticut
^b Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut
^c Department of Dermatology, University of Florida, Gainesville, Florida
^d Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children’s Medical Center, Hartford, Connecticut

^∗Correspondence to: Jane M. Grant-Kels, MD, Department of Dermatology, UConn Health, 21 South Road, Farmington, CT 06032.Department of DermatologyUConn Health21 South RoadFarmingtonCT06032

Abstract

Child abuse and neglect remains a significant cause of morbidity and mortality in children. Dermatologists may not fully conceptualize their crucial role in the evaluation of child abuse and neglect as both mandated reporters and experts in skin pathology. This CME article summarizes the current information on cutaneous signs and clinical signs of abuse for dermatologists so that they gain more insight into the skin examination for child abuse and neglect, develop confidence in their ability to distinguish dermatologic signs of accidental versus inflicted trauma, and more frequently consider abuse and neglect in their differential diagnosis.

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Key words : bruising, child abuse, child maltreatment, child neglect, sentinel injuries, mandated reporting, pediatric dermatology

Abbreviation used : ED

Plan

Introduction

Sentinel injuries in infancy: what are they and why are they important?

Definition of sentinel injury

Seriousness of minor injury in the premobile infant

Provider role in identifying sentinel injuries and referring to pediatric ED for immediate full evaluation

Bruises beyond infancy: when to worry?

Significance of injury location

Significance of patterned injuries

History and examination

Obtaining the history

Limitations of history taking

Physical examination

Documentation and reporting

Importance of photodocumentation

Importance of a companion diagram

Documentation of history

Mandated reporting to child protective services

Communicating with families

	Funding sources: None.
	IRB approval status: Not applicable.
	Date of release: September 2022.
	Expiration date: September 2025.
	Accepted for publication November 12, 2021.
	Reprints not available from the authors.