Table 3.
American Academy of Pediatrics guidelines for evaluation of children under 2 years of age with injuries concerning for physical abuse
| Clinical scenario | American Academy of Pediatrics recommended evaluation |
|---|---|
| Noncruising infant <12 mo of age with a fracture(s) | Skeletal survey, CBC/platelets, AST/ALT |
| Infant <6 mo of age with bruise(s) | Skeletal survey, neuroimaging (CT or MRI), CBC/platelets, PT/PTT, von Willebrand screen, Factor VIII, Factor IX (von Willebrand and factors not needed if bruise in the shape of an object), AST/ALT |
| Infant 6 to<12 mo of age not yet cruising with a bruise(s)a | Skeletal survey, CBC/platelets, PT/PTT, von Willebrand screen, Factor VIII, Factor IX (von Willebrand and factors not needed if bruise in the shape of an object), AST/ALT |
| Infant <12 mo of age with a non–motor vehicle–associated intracranial hemorrhageb | Skeletal survey, CBC/platelets, PT/PTT, Factor VIII, Factor IX, d-dimer, fibrinogen, AST/ALT |
| Children <2 y of age reported to Child Protective Services for concerns of physical abuse | Skeletal survey |
ALT: alanine aminotransferase; AST: aspartate aminotransferase; CBC: complete blood count; CT: computed tomography; MRI: magnetic resonance imaging; PT: prothrombin time; PTT: partial thromboplastin time.
a
Other than a single bruise to a bony prominent after an age-appropriate trauma (eg, child 8 mo of age with a bruise to the forehead after a fall off a bed).
b
Not relevant for general emergency departments because infants with intracranial hemorrhage would all be transferred to a pediatric level I trauma center.