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06-Jul-2017 13:04

Finally, the effect of the physical abuse may not be limited to just the immediate injury findings.The National Center on Child Abuse and Neglect (NCCAN) estimated that 37% of children with maltreatment injuries developed a disability or special need, directly from the abusive actions or omissions of the child's caregivers.The child may have certain characteristics that make providing care more complex; however, caution must be used in considering the child's contribution to the abusive interactions.A "difficult" child does not justify abusive treatment by a caregiver.Physical child abuse (ie, nonaccidental injury that a child sustains at the hands of his or her caregiver) can result in skeletal injury, burns, bruising (see the first image below), and central nervous system injury from head trauma (see the second image below).To determine whether a child's injury was likely to have been inflicted rather than accidental, the clinician must establish the full extent of the injury and must understand the child's developmental level and abilities.The caregiver is viewed as having a personal developmental history, personality style, psychological functioning, and coping strategies.

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Fractures that raise a high degree of suspicion for inflicted injury include the following: Screening for abdominal injury is recommended in children younger than 5 years in whom abuse is suspected, even in the absence of clear external evidence of abdominal injury or symptoms such as pain or vomiting.Screening includes the following markers Psychosocial management that requires a significant amount of coordination among various services providers, including the physician and other health care providers, complements the medical management.The details of the caregiving environment determine the psychosocial supports needed to keep the child safe.The federally funded Fourth National Incidence Study (NIS-4) is a congressionally mandated effort of the United States Department of Health and Human Services to provide updated estimates of the incidence of child abuse and neglect in the United States and measure changes in incidence from the earlier studies.