Neuroimaging considerations in abusive head trauma.

This focused review on abusive head trauma describes the injuries to the head, brain and/or spine of an infant or young child from inflicted trauma and their neuroimaging correlates. Accurate recognition and diagnosis of abusive head trauma is paramount to prevent repeated injury, provide timely treatment, and ensure that accidental or underlying medical contributors have been considered. In this article, we aim to discuss the various findings on neuroimaging that have been associated with AHT, compared to those that are more consistent with accidental injuries or with underlying medical causes that may also be on the differential.

Genital Manifestations of Physical Abuse in Male Infants and Children.

We present 3 male patients with genital bruising due to physical abuse to improve recognition of genital trauma as a sentinel injury. In the absence of an underlying medical condition or a clear acceptable accidental mechanism for the genital injury, an evaluation for child abuse is recommended.

Medical Evaluations in Rhode Island for Suspected Child Abuse and Neglect Prior to and During the COVID-19 Pandemic.

During the COVID-19 pandemic, there was an increase in several risk factors for child maltreatment. There was also a sudden decrease in the systems available to identify and support at risk children and families. This study aims to describe the number of children presenting to specialized medical care for suspected child abuse and neglect during the first seven months of the COVID-19 pandemic compared to the three previous years. This was a retrospective chart review of all cases evaluated by the child abuse team in Rhode Island from March 1st until September 30th of 2017, 2018, 2019 and 2020. During the first seven months of the COVID-19 pandemic, there were 10% fewer children evaluated by the child abuse team with the most significant decrease (35%) in the number of children evaluated for physical abuse. With the known increased risk factors for physical abuse due to COVID-19, the decrease in the number of children evaluated for physical abuse is unlikely due to a decrease in the incidence of physical abuse. This decrease is most likely due to physical abuse not being identified or children not being referred to specialized medical care. Without the ability to see and interact with children in person, professionals' ability to identify child victims of abuse is limited. Professionals working with children and families at risk should develop strategies to be able to continue to provide in-person services in the future if another pandemic or natural disaster occurs.

Anogenital HSV in Children: Should Providers Be Concerned for Sexual Abuse?

OBJECTIVE: Anogenital herpes simplex virus (HSV) is most commonly acquired via sexual transmission, although other nonsexual modes of transmission have been proposed. When a child presents with a first-time outbreak of anogenital HSV, providers must consider sexual abuse. There are currently no evidence-based consensus guidelines to inform management of these patients. The purpose of this study was to describe how child abuse pediatricians (CAPs) evaluate children with anogenital HSV infection and determine whether any consistent practice patterns are followed. PARTICIPANTS AND SETTING: The patients included in this study were children between the ages of 0 and 12 years with a first-time outbreak of anogenital HSV who were medically evaluated by a CAP. METHODS: Patient charts were retroactively reviewed for the period of January 1 2004 to May 1 2020. RESULTS: Twenty-two cases were referred for evaluation by a CAP in the chosen time frame. Fifteen were seen in person. Ten of these patients were interviewed, 15 had an anogenital exam with colposcopy, and 14 were tested for at least one other sexually transmitted infection. A diagnosis of sexual abuse was made for 1 patient. CONCLUSION: This study demonstrates that although nonsexual transmission of anogenital HSV may be possible, providers must still consider sexual abuse. Children with a first-time outbreak of anogenital HSV should have a comprehensive evaluation for sexual abuse, including interview, physical exam, and testing for sexually transmitted infections. Evidence-based concerns for sexual abuse should be reported to child protective services.