The physical exam

An abused or neglected child who is taken to a doctor will first have a general physical exam. The doctor will review the child's medical history and ask parents or caregivers questions about the child's condition.

A child who is able to talk will be separated from the caregiver during the interview.

The law requires doctors to consider the possibility of abuse or neglect. Along with seeing signs of physical abuse or neglect, a doctor may become suspicious when:

• The injury is unusual or is not likely to be an accident, especially for the child's age.
• The parents or caregivers don't have a good explanation, or the explanation changes.
• The parents or caregivers say no one saw the injury happen.
• Medical records show that similar injuries or patterns of neglect have occurred in the past.
• The parents or caregivers put off taking the child to the doctor without a good reason.
• The doctor finds signs of sexual abuse.

Other children in the care of the same person may also be examined and have X-rays if police or doctors think it's needed.

Common tests

Tests that are often used to help confirm or rule out abuse or neglect include:

• Imaging tests such as X-ray, CT scan, or MRI. These types of tests can help determine whether a child's injuries include any broken bones. Some tests may also show signs of past injuries.
• Blood tests. Prothrombin time, partial thromboplastin time, and platelet count can help determine whether the child has a bleeding disorder. Other blood tests can be used to look for signs of organ damage.
• Urinalysis, to check for blood in the urine. This can be a sign of internal injuries.
• Specialized lab tests. For example, the doctor may take skin or hair samples or samples of fluids in or around the vagina to be tested.
• Lumbar puncture, also called spinal tap, which may reveal blood from a brain injury.
• Eye exam, to find out if damage has occurred that points to shaken baby syndrome.

Other tests

Other exams and tests depend on the specific medical problem suspected or observed. For example:

• Psychological testing may be requested for some children.
• Victims of suspected sexual abuse may be tested for sexually transmitted infections.

Tracking a child's injuries

Information about a child's injuries is carefully recorded. A detailed account of the injuries goes into the child's permanent health record.

This record usually includes photographs and drawings of the injuries.

Measurements such as weight, height, and head circumference are also taken and recorded to help establish a child's baseline growth pattern. Recording these measurements on growth charts can help identify failure to thrive that sometimes is related to neglect.