TABLE 87.1 FINDINGS IN THE HISTORY THAT MAY BE SUGGESTIVE OF PHYSICAL ABUSE • No history of trauma provided to explain the injury • History is inconsistent with the injury • History is inconsistent with the developmental age of the child • History changes with time • History of sibling or home resuscitative efforts causing injuries • Conflicting histories provided from different caregivers • Unexplained or unexpected delay in seeking care Clinical Assessment The initial clinical assessment of a child with possible abusive injuries does not differ from the approach for a child with similar accidental injuries After the child is stabilized, further evaluation is necessary to determine the level of concern for abuse and guide next steps in ensuring the safety of the child Distinguishing abusive injuries from accidental injuries in the ED can be difficult as there are few single injuries pathognomonic for abuse and overlap exists in the spectrum of injuries resulting from accidental and abusive trauma Findings on history and physical examination, however, can help to identify cases concerning for abuse that warrant further evaluation ( Tables 87.1 and 87.2 ) A thorough history including history of trauma, developmental history, past medical history, and social history should be performed A complete physical examination including review of vital signs, thorough skin examination, intraoral examination, and neurologic examination should be performed in addition to the assessment of the presenting injury If available, photo documentation with a size standard or ruler should be performed for cutaneous findings ( Table 87.5 )