Monitoring

In children with a high suspicion of abuse, even when the initial skeletal survey is negative or equivocal, a repeat skeletal survey should be performed 11 to 14 days after the initial investigation, to give further information about ambiguous findings, identify further fractures, and add information about the age of a fracture.[10][149][180][181] In some countries, a radionuclide scan is an alternative approach. This may help identify injuries, particularly rib fractures not seen on the initial skeletal survey.[149] In the US, however, radionuclide scans are rarely used in children.

In patients suspected of abusive head trauma, a brain MRI scan should be performed, ideally 3 to 5 days following an initial brain CT, if any abnormality is detected. An MRI scan should also be considered if the initial CT scan is normal but there is a high index of suspicion.[155][159]​​

When physical abuse has been recognized, child protection procedures are implemented. These will vary according to the individual circumstances of the case. In some countries cases are registered on a register of children at risk, and the progress of the family and welfare of the child is monitored at regular intervals by the relevant social and healthcare agencies.

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