Which statement best describes the evaluation of head injury in children with possible abuse?

• A. Evaluate only if there are obvious signs of abuse.
• B. Abuse concerns are irrelevant in pediatric head injury.
• C. Only assess for abuse in elderly patients.
• D. Evaluate any child with head injury for signs of potential abuse.

Answer: (D)

In pediatric head injuries, always assess for potential abuse. Children may not be able to clearly describe what happened, and injuries can be inconsistent with the provided history or with what would be expected from reported events. Evaluating for abuse in every head injury helps catch nonaccidental trauma early, protecting the child and guiding appropriate care and reporting. The evaluation should be thorough and multidisciplinary: take a careful, nonleading history; perform a careful physical exam looking for injuries in multiple sites or in patterns uncommon with accidents; consider imaging and other tests as indicated; review prior injuries or patterns of injury that might suggest abuse; and involve child protective services when red flags are present. This approach recognizes that abuse concerns are not irrelevant and that cases can be subtle, so every head injury warrants safeguarding the child’s well-being rather than waiting for obvious signs.