As the number of children and youth with special health care needs increases, it is imperative that pediatricians garner the skills to identify patients at increased risk for abuse, to correctly differentiate child abuse and neglect from accidental injury or sequelae of specific disease processes, to appropriately report child abuse, and to integrate prevention strategies into the medical home for our most vulnerable patients.
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A 14-year-old boy with intellectual disability and moderate spastic cerebral palsy presents to the emergency department with 1 day of fussiness and pain. At examination, he is noted to be nonverbal and thin and has swelling and tenderness of his left thigh. On radiographs, he is noted to have diffuse osteopenia with cortical thinning, as well as a left midshaft femur fracture. When questioned about the injury, his parents report no history of trauma.
Child abuse is...