Child Abuse

The critical care physician plays an important role in the care of children who are victims of child maltreatment. This chapter will provide a brief overview of clinical situations and diagnostic tools that may be encountered in the intensive care unit. Since the subspecialization of child abuse medicine within the practice of pediatrics, several clinical tools have been developed, derived from evidence-based medical literature. These clinical tools aid medical teams in identifying injury characteristics or patterns such that physical abuse is appropriately placed in the differential diagnosis with a certain degree of sensitivity and specificity. The critical care team may utilize the child abuse team as a resource in identifying all types of child maltreatment such as child physical abuse, sexual abuse, neglect, and the various types of medical maltreatment due to caregiver-fabricated illness in a child (also known as medical child abuse or Munchausen syndrome by proxy). Management of these ICU patients frequently occurs in a multidisciplinary manner that includes a child abuse pediatrician. It is important to note that the child abuse pediatrician is a medical colleague and not a part of child protection services. Their role is to assist in the medical evaluation of patients, to diagnose child abuse or neglect, to evaluate and diagnose medical conditions that mimic abuse or neglect, to help the medical team document and report their findings to child protection services and law enforcement as needed, and to help develop a safety plan for the child and family.