- Failture to thrive (FTT), developmental delay
- Poor hygiene (dental, dirty clothes)
- No stranger anxiety, decreased attachment to parent
- Prolonged interval before presentation
- Conflicting histories
- Doctor shopping
- Unrelated signs of injuries
- What is the incident?
- Witnessed by person providing history?
- Does the history adequately explain the injury?
- Consistency? Detailed? Same account for all involved? Dominant historian?
- Location (accessibility)
- Size (always measure)
- Recording (draw, photograph)
- Fractures: especially of skull, long bones, ribs
- Mechanism of injury (force applied, amount needed)
- Head injury (subdural – irritable, lethargic, poor feeding, increased ICP, retinal hemorrhage)
- Eye injury
- Internal injury
– TAKE A GOOD HISTORY
– DO A PROPER PHYSICAL EXAM
– DOCUMENT INJURIES
– APPROPRIATE INVESTIGATIONS (XRAY, BONE SCAN, CT, US, BLOODWORK)
– ALERT CHILD WELFARE
– SOCIAL WORK CONSULT
– ENSURE SAFETY OF CHILD AND OF OTHER CHILDREN