Physical child abuse demands increased awareness during health and socioeconomic crises like COVID-19: A review and education material

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Background and purpose — Physical abuse of children,
i.e., nonaccidental injury (NAI) including abusive head
trauma (AHT) is experienced by up to 20% of children;
however, only 0.1% are diagnosed. Healthcare professionals
issue less than 20% of all reports suspecting NAI to the
responsible authorities. Insufficient knowledge concerning
NAI may partly explain this low percentage. The risk of NAI
is heightened during health and socioeconomic crises such
as COVID-19 and thus demands increased awareness. This
review provides an overview and educational material on
NAI and its clinical presentation.
Methods — We combined a literature review with expert
opinions of the senior authors into an educational paper
aiming to help clinicians to recognize NAI and act appropriately
by referral to multidisciplinary child protection teams
and local authorities.
Results — Despite the increased risk of NAI during the
current COVID-19 crisis, the number of reports suspecting
NAI decreased by 42% during the lockdown of the Danish
society. Healthcare professionals filed only 17% of all reports
of suspected child abuse in 2016.
Interpretation — The key to recognizing and suspecting
NAI upon clinical presentation is to be aware of inconsistencies
in the medical history and suspicious findings on
physical and paraclinical examination. During health and
socioeconomic crises the incidence of NAI is likely to peak.
Recognition of NAI, adequate handling by referral to child
protection teams, and reporting to local authorities are of
paramount importance to prevent mortality and physical and
mental morbidity.
Original languageEnglish
JournalActa Orthopaedica
Volume91
Issue5
Pages (from-to)527-533
Number of pages7
ISSN1745-3674
DOIs
Publication statusPublished - Nov 2020

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