Identifying clinical signs of child abuse in primary care: a systematic review.

Abstract

INTRODUCTION: Child abuse may be the cause of clinical signs that are often poorly understood, leading to an underestimation of violence. According to United Nations agencies, 1 billion children worldwide are victims of violence. OBJECTIVE: The objective of this study was to identify the clinical signs of abused children during a consultation in primary care. STUDY DESIGN: A systematic review was conducted in the PubMed, Cochrane, PsycInfo, Embase, and CINAHL databases from 1996 to January 2024. The studies included focused on children aged 0-18 who were victims of abuse and presenting in primary care. RESULTS: Among the 3811 articles found in the databases, 19 were included in the review. Signs of physical trauma included fractures, bruises, burns, and genital and neurological injuries. Somatic symptoms in children may include abdominal pain, persistent nonspecific symptoms, and atopic manifestations such as eczema or asthma. The psychological symptoms identified were depression, despair, and anxiety. Abuse is also associated with behavioral disorders (externalizing or internalizing behaviors) and developmental delays (language, learning, and social interaction disorders). CONCLUSION: Few articles have investigated the clinical signs of child victims of violence presenting in primary care. These children may present with various clinical signs (physical trauma, pain, atopy, psychological disorders, behavioral disorders, developmental delays) that highlight the importance of considering abuse as the cause.