University of Louisville School of Medicine, Louisville, KY, USA.
Am Fam Physician. 2013 Nov 15;88(10):669-75.
Child abuse is the third leading cause of death in children between one and four years of age, and almost 20% of child homicide victims have contact with a health care professional within a month of their death. Therefore, family physicians are in an ideal position to detect and intervene in cases of suspected child maltreatment. There is currently insufficient evidence that screening parents or guardians for child abuse reduces disability or premature death. Assessment for physical abuse involves evaluation of historical information and physical examination findings, as well as radiographic and laboratory studies, if indicated. The history should be obtained in a nonaccusatory manner and should include details of any injuries or incidents, the patient's medical and social history, and information from witnesses. The physical examination should focus on bruising patterns, injuries or findings concerning for abuse, and palpation for tenderness or other evidence of occult injury. Skeletal survey imaging is indicated for suspected abuse in children younger than two years. Imaging may be indicated for children two to five years of age if abuse is strongly suspected. Detailed documentation is crucial, and includes photographing physical examination findings. Physicians are mandated by law to report child abuse to the local child protective services or law enforcement agency. After a report is made, the child protection process is initiated, which involves a multidisciplinary team approach.
儿童虐待是 1 至 4 岁儿童死亡的第三大原因，近 20%的儿童凶杀案受害者在死亡前一个月内曾接触过医疗保健专业人员。因此，家庭医生非常适合发现和干预疑似儿童虐待的情况。目前尚无充分证据表明对父母或监护人进行儿童虐待筛查可减少残疾或过早死亡。身体虐待的评估包括评估病史和体格检查结果，以及影像学和实验室研究（如有指征）。病史的采集应采用非指责性的方式，包括任何伤害或事件的详细信息、患者的医疗和社会史以及证人的信息。体格检查应重点关注瘀伤模式、可能存在虐待的伤害或发现，以及触诊是否有隐匿性损伤的压痛。对于两岁以下疑似虐待的儿童，应进行骨骼调查成像。如果强烈怀疑存在虐待，可能需要对 2 至 5 岁的儿童进行影像学检查。详细记录至关重要，包括拍摄体格检查结果的照片。医生有法律义务向当地儿童保护服务或执法机构报告儿童虐待。报告后，启动儿童保护程序，涉及多学科团队方法。
