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
Recommendations
- 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
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