In a clinical report issued by the American Academy of Pediatrics and published in Pediatrics, recommendations are presented to help guide pediatricians in assessing bleeding disorders when child abuse is suspected. James Anderst, MD, and colleagues based the recommendations on evidence for pediatricians to distinguish abusive from accidental bruising from an accompanying technical report. For evaluating possible abuse or medical conditions that predispose to bleeding/ bruising, recommendations include complete medical, trauma, and family histories; screening for unusual or restrictive diets; and a thorough physical examination. Family and medical history alone do not effectively predict bleeding disorders. Careful consideration of a potential medical condition causing bleeding/bruising is essential in each case, with specific elements of the history, developmental status of the child, and characteristics of the injury useful for determining the need for laboratory evaluation. Initial testing, when necessary, should be focused on the prevalence of the condition and the potential for each condition to cause the specific findings. Tests should be selected based on the ability to detect specific bleeding disorders and can be tailored based on the patient. In children with bruising/bleeding potentially indicating abuse, including intracranial hemorrhage and especially subdural hemorrhage, consultation with child abuse pediatricians and/or pediatric hematologists should be strongly considered.
