Facialabuse Facial Abuse Maternal Maltreatm Upd |work| Here

Scope

• Target population: infants and young children with suspected facial injury from abuse, especially where caregiver (including mother) maltreatment is suspected.
• Goals: medically evaluate injuries, document findings for safety/forensic purposes, identify other injuries/neglect, assess immediate safety needs, and guide reporting/referral.

History (obtain from caregiver and, if possible, independently)

• Chief complaint & timeline: when/how injury occurred; who was present; developmental capabilities of the child.
• Mechanism described: object, hand, fall, collision; consistency with injury pattern.
• Past medical history: bleeding disorders, prior injuries, medications, developmental milestones.
• Social history: caregiver relationships, prior CPS involvement, substance use, domestic violence, mental health issues.
• Discrepancies: note any inconsistencies between history and exam.

Multidisciplinary referrals

• Child protection services / social work
• Forensic pediatrician or child abuse pediatric specialist
• Ophthalmology (retinal exam)
• Radiology
• Psychiatry/psychology (child and caregiver when appropriate)
• Law enforcement when indicated and per local policy

Title

Facial Abuse and Maternal Maltreatment: Definitions, Prevalence, Consequences, and Recommendations

Physical exam — systematic, head-to-toe

• Environment: well-lit room, high-resolution camera (include ruler/scale), same examiner if possible.
• General: appearance, behavior, interaction with caregiver, signs of neglect (malnutrition, poor hygiene).
• Head/face/neck:
  • Inspect and palpate scalp, face, periorbital areas, nose, ears, oral cavity, gingiva, lips, frenulum, mandible, TMJ.
  • Document size, shape, color, location, and age-estimate of lesions (e.g., erythema, abrasions, ecchymoses, lacerations, patterned injuries, burns).
  • Note intraoral injuries, frenulum tears, dental injuries, tongue injuries.
  • Assess for signs of shaking/abusive head trauma: altered consciousness, vomiting, seizures, retinal hemorrhages (see below).
• Eyes:
  • External exam and pupil reactivity.
  • Dilated fundoscopic exam when indicated to look for retinal hemorrhages; document findings or arrange ophthalmology.
• Neurologic: level of consciousness, tone, reflexes, focal deficits.
• Skin: full-body skin exam with attention to patterned bruises (handprints, loop marks), linear marks, petechiae, burns, bite marks.
• Skeletal: palpate limbs, spine; assess for tenderness, swelling, limited use — get skeletal survey if indicated.
• Abdomen/genitourinary: evaluate for tenderness, signs of sexual abuse if relevant (specialist exam).