Noncutaneous Conditions Triggering Evaluation for Child Abuse

F. Bruder Stapleton, MD

Metabolic bone disease was the most common mimic category that led to referral.

Pediatricians must be vigilant for signs of child abuse while also recognizing that unsubstantiated concerns for abuse can have devastating effects on families. To ascertain which noncutaneous conditions most commonly raise concern for child abuse, investigators conducted a prospective analysis of 2890 children in the ExSTRA (Examining Siblings To Recognize Abuse) network who were referred for suspected child abuse. Of these children, 137 (5%) had mimics of abuse.

This analysis focused on the 81 children (60%) with noncutaneous conditions mimicking abuse. Based on a likelihood-for-abuse scoring scale, 23 children were assigned high or intermediate levels of concern for abuse. Noncutaneous mimics included metabolic bone disease (28%); hematologic or vascular conditions (20%); infections (16%); skeletal dysplasia (10%); neurologic (9%), oncologic (5%), or gastroenterologic (2%) conditions; and other disorders (10%). Diagnoses were confirmed with imaging, skeletal surveys, and hematology consultations. The most common mimics were osteomalacia and vitamin D deficiency rickets.

Citation(s):

Metz JB et al. Non-cutaneous conditions clinicians might mistake for abuse. Arch Dis Child 2014 Apr 19; [e-pub ahead of print].