Outpatient Specialty Care and Primary Care Pathway for Evaluation/Treatment of Children with Physical Abuse Concerns

No Findings Suggestive of Abuse
  • No injuries or risk factors indicating abuse present
  • No historical indicators of abuse
  • Physical exam findings explained by plausible developmentally appropriate mechanism or medical etiology
  • No safety concerns
Findings Suggestive of Abuse
  • Witnessed or disclosed abuse
  • Injury pathognomonic for abuse
  • Injuries Suggestive of Abuse not explained by plausible mechanism
  • Multiple injuries
  • Suspicious occult injuries identified by patient workup
  • Infant’s head circumference > 85% or increased at least 2SD from prior measurement
  • Irritability in infants without identifiable cause
  • Social history of substance use, IPV or violent criminal history of adult in home
  • Note:
  • Age < 6 months with any injury warrants consideration of suspected abuse
  • Household contacts or siblings of children with abusive injuries are at high risk
  • Consider ED referral, as clinically indicated
  • No further work up for abuse
  • No CPS report indicated
  • Routine follow-up
  • Discharge home
Concern for Abuse
  • ED Referral
  • Age < 2 years with any concern for possible abuse
  • Findings suggestive of abuse requiring further evaluation
  • ED Physical Abuse Pathway
  • Historical or social concerns that require social work consultation
  • Injury that requires further evaluation, treatment
  • Child accompanied by social services for abuse evaluation

  • CPS Referral for the following:
    • Immediate safety concerns for discharge
    • Concern for other children at risk in the home
  • Communication
    • PCP contacts referral line 215-590-2160
    • Speaks with MCP as indicated, leaves cell number
    • Assures patient arrives ED
    • CPS referral as indicated
Posted: September 2018
Revised: June 2021
Authors: P. Scribano, MD; J. Wood, MD; K. Henry, MD; V. Scheid, MD; L. Palacio, LSW; C. Jacobstein, MD; J. Lavelle, MD