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Intentional injury of the skin in children (including bruises but beyond temporary redness) should alert pediatricians to child abuse, according to a recent report released by the Committee on Child Abuse and Neglect of the American Academy of Pediatrics. One of the problems in determining child abuse, the committee concluded, is that states set the bar too high on which cases to investigate, so even minor cases go without investigation. The committee identified some consequences of the way doctors and other specialists label child abuse: (1) children who are abused but aren’t protected often end up in more serious harm later on; (2) physical injuries are frequently only an external manifestation of extreme psychological damage and abuse. In order to help more children who slip through the cracks, the committee put forth the following recommendations: —Pediatricians need to recognize non-accidental injuries as abuse. —Abuse should be deemed the most likely explanation for those injuries. —Legislation should be enacted to change the definition of child abuse, including non-medical definitions that encompass non-accidental skin injuries. —States should work with social service agencies to implement these laws. Pediatricians should provide counsel or provide appropriate referral to assist caregivers with proper behavior management of children.
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