The most important step in making the correct diagnosis is to consider abuse. Abuse should always be thought of if any of the following occur:
- If the story does not explain the nature or degree of the injury
- If the story is vague or keeps changing
- If the child reports or hints at abuse
- A delay in seeking medical help
- Repeated or multiple injuries
- Any unusual type of injury
- An inappropriate emotional state or behaviour of the parents or child
- Pregnancy or a sexually transmitted infection in a child under 16 years
The most important sign of abuse is a history that does not adequately explain the degree or nature of the injury.
Unfortunately, the diagnosis of child abuse is often missed as it is not considered. Almost half of all abused children do not have physical injuries.
The most important step in the diagnosis is to consider child abuse.