Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Child Abuse and Neglect Recognition

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In one line

·Think abuse when the injury story does not match the injury itself or what a child that age can do.

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Normal physiology

·Healthy children are cared for by adults who keep them safe, fed, clean, and protected from harm. Injuries in normal childhood are accidental, match the developmental stage (what the child can do at that age), and have a clear, consistent story.

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What goes wrong

·Abuse is when an adult or older child intentionally harms a child—hitting, shaking, burning, sexual contact, cruel words, or failing to give basic needs like food or medical care. The upstream break is the loss of protection and safety.

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Hallmark signs

·Injury does not match the story or age
·Many injuries in different healing stages
·Waiting too long to come in
·Story keeps changing or is different each time
·Bruises in unusual spots (ears, neck, belly, back, buttocks, genitals)
·Patterned marks (belt, hand, cord, bite)
·Child is fearful, withdrawn, or overly watchful of adults
·Poor hygiene, malnutrition, or untreated medical needs

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Red flags · escalate now

·Injury that cannot happen by accident at that age (e.g. broken bones in a baby who is not yet walking)
·Caregiver story that keeps changing or does not make sense
·Bruises, burns, or fractures in different stages of healing
·Patterned injuries (belt marks, hand prints, bite marks, cord loops)
·Delay in seeking care for a serious injury without a clear reason

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Workup

·Skeletal survey (full-body x-rays per AAP protocol: 2 views each limb, skull, spine, ribs, pelvis)
·Non-contrast CT of the head (if any concern for head trauma, altered mental status, vomiting, seizure, or bruising on head/face)
·Dilated retinal exam by ophthalmology (mandatory if any suspicion of abusive head trauma)
·Coagulation panel: PT, aPTT, platelet count, and sometimes von Willebrand factor or factor VIII/IX if unexplained bruising
·Liver and pancreatic enzymes: AST, ALT, amylase, lipase (if abdominal trauma suspected—bruising, vomiting, abdominal tenderness)
·Urinalysis and urine culture (if neglect suspected or unexplained fever, poor hygiene, untreated illness)
·Forensic sexual assault examination by trained SANE nurse or child abuse pediatrician (if sexual abuse suspected—genital injury, bleeding, discharge, behavioral signs, or disclosure)
·Screening for sexually transmitted infections: gonorrhea, chlamydia (NAAT), HIV, syphilis, hepatitis B/C if sexual abuse suspected

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Treatment

·Immediate safety assessment and separation from suspected abuser if the child is in danger
·Detailed documentation with body maps, measurements, and high-resolution photographs of every injury under standard lighting
·Mandatory report to Child Protective Services and law enforcement immediately (legally required in all 50 U.S. states)
·Hospitalization for medical stabilization, further work-up, and multidisciplinary team coordination (pediatrician, social work, child psychiatry, forensic nurse, child abuse specialist)
·Trauma-informed therapy and mental health support for the child (play therapy for young children, cognitive-behavioral therapy for older children)
·Medical treatment of injuries: fracture stabilization, wound care, treatment of infections, nutrition support if malnourished
·Education and support for non-offending caregivers (if one parent did not know or was also a victim)

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NCLEX trap

·Child abuse happens in every kind of family. Your job is to match the injury to the story. If the bruise pattern, bone break, or burn does not fit what the adult says happened, that mismatch is your red flag — no matter how the adult looks or sounds.
·Normal play bruises sit on the shins, knees, elbows, and forehead — the bony parts that hit the ground when a child trips. Bruises on soft places like the ears, neck, belly, genitals, inner thighs, or buttocks almost never come from accidents. Those are red flags for abuse.
·You are a mandated reporter by law in every U.S. state. That means if you suspect abuse or neglect, you must call the hotline yourself. Do not wait for someone else to do it. Reporting protects you legally and protects the child immediately.
·The law says you report reasonable suspicion, not proof. Child protective services and police investigate to find proof; that is their job, not yours. If you wait for proof, the child may be hurt again. The law shields you from lawsuits when you report in good faith.
·Abuse includes hitting, shaking, burning, and sexual touching. Neglect means not feeding the child, leaving them alone for long periods, skipping medical care, or keeping them in filthy or unsafe conditions. Emotional abuse means constant yelling, humiliating, or threatening the child. All of these hurt development and all must be reported.
·Young children often cannot put abuse into words, or they are too scared to tell because the abuser threatened them. Your suspicion comes from the exam findings, the mismatch between injury and story, and patterns like multiple injuries at different ages — not from waiting for the child to speak up.

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