Physical abuse is commonly a chronic, escalating disease. Pediatricians, emergency physicians, and other front-line clinicians have the essential role of recognizing abuse early, when signs are subtle, and when the history is often incomplete or misleading. These data support a lower threshold to consider abuse in young children who present with relatively minor injuries after a new care arrangement, especially when the new caregiver is not biologically related, like the mother's boyfriend. Serious abuse is most commonly missed in young children, especially those that are not yet walking or talking. Relatively subtle signs include bruising (the subject of this study) as well as oral injuries, fractures, other sentinel injuries,1,2 or early signs of occult brain injury.3 Most importantly, these data support expanding abuse prevention efforts to include unrelated caregivers and providing childcare assistance to high-risk families. The extraordinarily high odds ratios may tempt clinicians to use these data to speculate about who perpetrated the abuse, but given the high stakes, and the clinician's limited role, this is to be discouraged.
Language: en
%G en %I Elsevier Publishing %@ 0022-3476 %U http://dx.doi.org/10.1016/j.jpeds.2019.10.073