AAP "Cheat Sheet" on Abuse:

þ Just a Cheat Sheet Suspected Child Physical Abuse 
 - Consider abuse in any child from any family with any injury when: 
  + Multiple injuries to multiple organ systems 
  + Denial of trauma in child with significant injury 
  + History inconsistent with injury 
  + History incompatible with child's development 
  + History that changes with time 
  + Unexpected and unexplained delay in seeking treatment 
 - Suspected Abusive Head Trauma (Including "Shaken Baby Syndrome") 
  + Brain CT or MRI 
  + Skeletal survey* for child under age 2 
  + Retinal exam (preferably by pediatric ophthalmologist) 
  + Standard labs** 
  + Hospital admission to pediatric center 
  + Report to Child Protective Services*** 
 - Suspected Abusive Fracture(s) 
  + Skeletal survey* for child under age 2 
  + standard labs** plus calcium, phosphorus, alkaline phosphate 
  + Brain CT or MRI for infants (<1 y/o) and consider brain CT or MRI for 1-2 
    y/o 
  + Consider hospital admission 
  + Report to Child Protective Services 
 - Suspected Abusive Burns 
  + Skeletal survey* for child under age 2 
  + Photo-document if possible 
  + Consider standard labs** plus electrolytes 
  + Consider hospital admission/pediatric burn center 
  + Report to Child Protective Services*** 
 - Suspected Abusive Abdominal Trauma 
  + Skeletal survey* for child under age 2 
  + Abdominal imaging 
  + Standard labs** 
  + Brain CT or MRI for infants (<1 y/o) and consider brain CT or MRI for 1-2 
    y/o 
  + Hospital admission 
  + Report to Child Protective Sen/ices*** 
 - Suspected Abusive Bruising 
  + Skeletal survey* for child under age 2 
  + Photo-document, if possible 
  + Standard labs** 
  + Consider brain CT or MRI 
  + Consider hospital admission 
  + Report to Child Protective Services*** 
* Skeletai survey (not a babygram) as per the American College of Radiology 
standards. Look for rib fractures, metaphyseal fractures, skull fractures, long 
bone fractures. Consider repeat skeletal sun/ey in 2-3 weeks to better identify 
rib and metaphyseal fractures. 
** standard labs include: CBC with platelet count, PT/Pn/INR, 
LFTs, amylase, lipase, U/A. 
*** Child Protective Services referral: 
Pennsylvania: 1-800-932-0313 
For free child abuse education, visit: 
www.pascan.org 
American Academy of Pediatrics ^ 
Pennsylvania Chapter