Diagnosing physical child abuse: the way forward

Abstract

Each year in England and Wales, as many as 40 000 children are the subject of a case conference for suspected physical abuse. Abuse has major physical and psychological consequences for the health and welfare of the affected children. The evidence indicates that a significant proportion of abused children experience serious long term effects and they carry the legacy of their abuse with them into adult life.1,2 The management and diagnosis of abuse in children is therefore of great importance. The management of child abuse must start with accurate diagnosis. With such an important subject one would expect there to be a considerable number of publications giving quantitative evidence on which to base diagnosis. Unfortunately, this is not the case and there has been little work giving probabilities for diagnosis, risk, and outcome for the abused child. In this article, we will review the evidence we have on the diagnosis of physical abuse in children. We will also review the differential diagnosis, the process of differentiation of physical abuse from accident, and what basis we have for giving evidence to the child protection process.