Paeds Vivas · child-safety-and-social-paediatrics
Physical abuse: bruising and sentinel injuries — branching viva
Branching viva on inflicted bruising, the TEN-4 FACES-L rule, sentinel injuries, the bleeding-disorder differential, skeletal survey and the safeguarding pathway.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar managing a sequence of linked child-protection problems: a bruised non-mobile infant, then an older child with multiple high-specificity bruises and a normal coagulation screen. The examiner will challenge your recognition, your investigations, your differential and your safeguarding response.
Stem
You are in a mixed acute paediatric setting. The examiner will move you through recognition, investigation, differential and safeguarding. [4] [2]
References8ShowHide
- [1]Pierce MC Bruising characteristics discriminating physical child abuse from accidental trauma. Pediatrics, 2010.PMID 19969620
- [2]Sheets LK Sentinel injuries in infants evaluated for child physical abuse. Pediatrics, 2013.PMID 23478861
- [3]Sugar NF Bruises in infants and toddlers: those who don't cruise rarely bruise. Puget Sound Pediatric Research Network. Archives of pediatrics & adolescent medicine, 1999.PMID 10201724
- [4]Christian CW The evaluation of suspected child physical abuse. Pediatrics, 2015.PMID 25917988
- [5]Pierce MC Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA network open, 2021.PMID 33852003
- [7]Letson MM Prior opportunities to identify abuse in children with abusive head trauma. Child abuse & neglect, 2016.PMID 27680755
- [9]Maguire S Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries. Archives of disease in childhood, 2007.PMID 17468129
- [11]Hultman L Testing for bleeding disorders in child abuse: AAP recommendation adherence and testing results. Child abuse & neglect, 2025.PMID 40158474