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Abuse, Pediatric (Nonaccidental Trauma [NAT]), Emergency Medicine

Reviewed 06/2017



  • Child abuse impacts up to 14 million or 2–3% of US children each year.

  • 1,200–1,400 children die of maltreatment each year in the US. Of these, 80% <5 yr and 40% <1 yr.

  • Mandated r...


Signs and Symptoms


  • History and mechanism inconsistent with the injury or illness:

    • Unexplained death, apnea, and injury

    • Unexplained ingestion or toxin exposure

    • Recurrent injury

    • Parent/careg...



  • Diagnosis relies on physical evidence in child and inconsistency with the history and mechanism.

  • Examination of the scene may be useful:

    • Evaluate validity of mechanisms

    • General appe...



Admission Criteria

  • Observation and intervention for traumatic injury

  • Concerns about disposition or lack of availability of child welfare receiving site, if required

  • Goal must always ...

Pearls and Pitfalls

  • A history inconsistent with the physical findings should lead to a suspicion of NAT.

  • When child abuse is suspected, it must be reported.

Additional Reading

  • American Academy of Pediatrics, Committee on Child Abuse and Neglect. Evaluation of suspected child physical abuse. Pediatrics.  2007;119:1232.

  • Guenther  E, Knight  S, Olson  LM...



  • 995.50 Child abuse, unspecified

  • 995.53 Child sexual abuse

  • 995.54 Child physical abuse

  • 995.51 Child emotional/psychological abuse

  • 995.52 Child neglect (nutritional)

  • 995.55 Shaken baby syndrome

  • 995....

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