ED Pathway for Evaluation/Treatment of Children with Physical Abuse Concerns

History and Physical

* Non-accidental trauma is difficult to detect in infants. Many present with non-specific symptoms such as irritability, ALTE, altered mental status or unexplained vomiting.

  Infants < 1 yr* Children
HPI
  • Onset of symptoms, activity at symptom onset
  • Nature of symptoms
  • Alleviating/exacerbating factors
  • Feeding: duration, frequency of feed, intake over past 24 hours
  • Presence of fever
  • History of injury
Details of Injury
  • Time
  • Mechanism
  • Initial manifestations
  • Neurologic symptoms
  • Supervision at time of injury
  • If delay in seeking care, reason for the delay
PMH
  • Birth history
  • Prior ED visits
  • Prior hospitalization
  • Primary care MD-date of last visit
  • Immunization status
Same
Development Normal vs abnormal Same
PE
  • Review VS
  • Neurologic exam
  • Thorough skin exam
  • Assess injury if present
Same