What formal evaluations should contact children of abused children undergo?
Contact children who are younger than 5 years should undergo a history and physical examination. Children younger than 12 months should have an MRI and skeletal survey. Children 12 months to 24 months of age should have a skeletal survey. No routine imaging is indicated in asymptomatic children older than 24 months. Children with positive findings should be investigated as an abused child.
Plan de l'etude:
Members of the International Consensus Group on Contact Screening in Suspected Child Physical Abuse used systematic reviews to guide the development of consensus guidelines on managing contact children when another child is suspected of having been physically abused. The guideline applies to contact children younger than 5 years. A contact child is defined as asymptomatic and either a sibling, household member, or in the same care setting as the abused child. The panel recommends a formal history and physical examination of all contact children. If any positive findings are elicited at that step or in any subsequent assessments, then a formal report and investigation is needed. If nothing indicating abuse is found and the child is older 2 years, the panel recommends no further assessment. If the child is younger than 1 year, the panel recommends magnetic resonance imaging (MRI) of the brain (followed by a spine MRI if the brain MRI result is abnormal), plus a full skeletal survey. For this age group, the panel also recommends limited-view skeletal surveys at 11 to 14 days if the initial survey identifies equivocal or abnormal findings and a follow-up MRI if the initial one is abnormal. For children 1 to 2 years of age, the panel recommends a full skeletal survey with limited-view skeletal surveys at 11 to 14 days if the initial survey identifies equivocal or abnormal findings.
Henry C. Barry, MD, MS
Michigan State University
East Lansing, MI