CHAPTER 87 ■ CHILD ABUSE/ASSAULT JOANNE N WOOD, JOAN CONNELLY, JAMES M CALLAHAN, CINDY W CHRISTIAN GOALS OF EMERGENCY CARE Prompt recognition and evaluation of injuries resulting from physical abuse is important to allow for (1) appropriate treatment of the presenting injury, (2) identification of occult injuries including fractures, traumatic brain injury (TBI), or intra-abdominal injury that may require medical intervention, and (3) protection of the child and possibly other children from further injury Distinguishing abusive injuries from accidental injuries in the emergency department (ED), however, can be challenging especially in young, preverbal children due to the potential unreliability of caregiver histories and limitations of physical examination in this population Thus, providers should consider the possibility of physical abuse in young children with injuries without a clear accidental etiology In children with injuries suspicious for abuse, a thorough evaluation including history and physical examination should be performed once the patient is medically stabilized ( Tables 87.1 to 87.3 ) Depending on the age of the child, radiologic and laboratory testing for occult injuries may be indicated as young victims of physical abuse presenting with minor injuries may have more serious clinically occult injuries ( Table 87.4 ) A report to child protective services (CPS) must be made if the provider has reasonable suspicion that the child may be a victim of abuse Physicians and nurses are mandated reporters of child abuse in all states; in many states, other healthcare workers are also mandated reporters ED providers should be familiar with the mandatory child abuse reporting laws governing the area in which they practice Failure to recognize, evaluate, and report cases of physical abuse can result in children suffering complications from injuries undiagnosed at the time of presentation, and keeps children vulnerable to future abuse that can lead to additional injuries and death KEY POINTS