Bleeding disorders, photodermatitis, salicylate ingestion, Henoch-Schonlein purpura, vasculitides, and Mongolian spots are commonly mistaken for nonaccidental bruising. Additionally, cultural treatments such as cupping, coining, and spooning are often mistaken for abusive injury.²⁶

Summary

Emergency physicians have an important responsibility to help to combat the “silent epidemic” of child abuse. We are often the last or only providers who can prevent a child from suffering severe injury or death from abuse. Careful matching of history, physical examination, radiographic findings, and developmental capabilities is imperative when evaluating a child for nonaccidental trauma. A high index of suspicion is needed for detecting the more subtle presentations.

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