Siblings of Children with Suspected Physical Abuse – When to Image

June 14, 2023

Written by Rebecca White

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Asymptomatic contact children of patients presenting with physical abuse are a vulnerable population who should be screened for traumatic injuries. This report details guidelines for radiologic screening.

Why does this matter?
There is an increased likelihood of non-accidental trauma (NAT) in the contacts of index children presenting with suspected physical abuse. Unfortunately, there are currently no screening guidelines for contact children, and it is often omitted, allowing occult injuries to go unnoticed. How can we tell which contact children need potentially lifesaving screening imaging?

The proof is in the imaging
This consensus statement was developed by 26 experts in the International Consensus Group on Contact Screening in Suspected Child Physical Abuse after three meetings and systematic literature review. They define contact children as asymptomatic siblings, cohabitating children, or children under the same care as an index child presenting with signs or symptoms of suspected NAT. Contact children are also victims of NAT in up to 37% of cases.

All contact children should undergo a thorough history and physical examination prior to imaging. Contact children younger than 12 months should have neuroimaging (ideally MRI, can also use low-dose non-contrast CT head with slices ≤ 1mm) and skeletal survey. Contact children 12 to 24 months should undergo skeletal survey. No routine imaging is indicated in asymptomatic children two to five years old.

Follow-up skeletal survey with limited views is recommended if initial assessment is abnormal or equivocal. A contact child with positive findings should be investigated as an index child.

Source
International Consensus Statement on the Radiological Screening of Contact Children in the Context of Suspected Child Physical Abuse. JAMA Pediatr. 2023 May 1;177(5):526-533. doi: 10.1001/jamapediatrics.2022.6184.