Diagnostic Criteria for Battered Child Syndrome

Key Diagnostic Features

The American College of Radiology recommends that subdural hematoma, bilateral femoral fractures, and ecchymosis in unusual locations be considered highly specific for abuse 1, 2, 3
The presence of multiple fractures in any location without overt trauma is strongly associated with abusive injury, according to the American College of Radiology 2, 3, 4
Femoral fractures in non-ambulatory children are more likely to be caused by abuse than falls, as stated by the American Academy of Pediatrics 5
The American College of Radiology suggests that femoral fractures in a child who is not yet walking and unexplained fractures should be considered suspicious for abuse 1, 2, 3

A complete skeletal survey is mandatory in cases of suspected child abuse, as 11% to 20% of infants undergoing evaluation for abuse have unsuspected fractures, according to the American College of Radiology 4
The American Academy of Pediatrics recommends that a funduscopic examination be performed to check for retinal hemorrhages, which are characteristic findings in abusive head trauma 6
Child protective services must be notified immediately in cases of suspected child abuse, as stated by the American College of Radiology and the American Academy of Pediatrics 2, 6