Child maltreatment recognition and response — branching viva

Branching structured-oral viva on recognising and responding to child maltreatment: the sentinel injury, the TEN-4-FACEsp bruising rule, the abusive-head-trauma workup, the mandatory-reporting trigger, and the toxic-stress mechanism.

branching clinical structured oral3 min readVerification in progress

Prompt

You are the general paediatrician on call. A 3-month-old infant who does not yet roll is referred from the emergency department with a single small bruise on the ear and a small bruise over the cheek, attributed to a feed-bottle knock. The infant is alert and afebrile. The registrar asks you whether the family can go home.

Opening question

Examiner: The registrar wants to send this infant home as a minor accidental bruise. Would you? Why? ^[8]

Candidate: No, I would not send the child home on that basis. This is a sentinel injury — a visible minor injury in a pre-mobile infant whose stated mechanism does not fit. A three-month-old who cannot yet roll cannot plausibly bruise the pinna and the cheek on a feed-bottle. Sentinel injuries are the most preventable miss in paediatrics: roughly one in three such infants has occult abuse found on workup, and the injury may precede a fatal event. I would document, examine fully, investigate, and report, in parallel. ^[8] ^[9]

References8Show

[2]Gilbert R; Kemp A; Thoburn J; et al Recognising and responding to child maltreatment. Lancet, 2009.PMID 19056119
[3]Felitti VJ; Anda RF; Nordenberg D; et al Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 1998.PMID 9635069
[6]Pierce MC; Kaczor K; Aldridge S; et al Bruising characteristics discriminating physical child abuse from accidental trauma. Pediatrics, 2010.PMID 19969620
[7]Pierce MC; Magana JN; Kaczor K; et al Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA Network Open, 2021.PMID 33852003
[8]Sheets LK; Leach ME; Koszewski IJ; et al Sentinel injuries in infants evaluated for child physical abuse. Pediatrics, 2013.PMID 23478861
[9]Lindberg DM; Beaty B; Juarez-Colunga E; et al Testing for Abuse in Children With Sentinel Injuries. Pediatrics, 2015.PMID 26438705
[12]Cowley LE; Morris CB; Maguire SA; et al Validation of a Prediction Tool for Abusive Head Trauma. Pediatrics, 2015.PMID 26216332
[14]Jenny C; Rieth KG Mild abusive head injury: diagnosis and pitfalls. Child's Nervous System, 2022.PMID 36637470

Child maltreatment recognition and response — branching viva

branching clinical structured oral3 min readVerification in progress

Opening question

Examiner: The registrar wants to send this infant home as a minor accidental bruise. Would you? Why? ^[8]

References8Show

[2]Gilbert R; Kemp A; Thoburn J; et al Recognising and responding to child maltreatment. Lancet, 2009.PMID 19056119
[3]Felitti VJ; Anda RF; Nordenberg D; et al Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 1998.PMID 9635069
[6]Pierce MC; Kaczor K; Aldridge S; et al Bruising characteristics discriminating physical child abuse from accidental trauma. Pediatrics, 2010.PMID 19969620
[7]Pierce MC; Magana JN; Kaczor K; et al Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA Network Open, 2021.PMID 33852003
[8]Sheets LK; Leach ME; Koszewski IJ; et al Sentinel injuries in infants evaluated for child physical abuse. Pediatrics, 2013.PMID 23478861
[9]Lindberg DM; Beaty B; Juarez-Colunga E; et al Testing for Abuse in Children With Sentinel Injuries. Pediatrics, 2015.PMID 26438705
[12]Cowley LE; Morris CB; Maguire SA; et al Validation of a Prediction Tool for Abusive Head Trauma. Pediatrics, 2015.PMID 26216332
[14]Jenny C; Rieth KG Mild abusive head injury: diagnosis and pitfalls. Child's Nervous System, 2022.PMID 36637470