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International Consensus Statement on the Radiological Screening of Contact Children in the Context of Suspected Child
Kshitij Mankad1,2, Jai Sidpra1,2, David M Mirsky3
1Department of Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
Insights
Guidelines for screening contact children for abusive injuries are now available. This ensures vulnerable children receive timely radiological assessment to prevent further abuse and long-term harm.
Area of Science:
- Pediatric Radiology
- Child Abuse
- Forensic Radiology
Background:
- Physical abuse is a major cause of childhood morbidity and mortality.
- Lack of screening guidelines for contact children with suspected abuse leads to undetected injuries and increased risk.
- Radiological assessment of contact children is often inconsistent, necessitating standardized protocols.
Approach:
- Systematic literature review and modified Delphi consensus process involving 26 international experts.
- Three consensus meetings were held between February and June 2021.
- Evidence-based best practices were developed for radiological screening.
Key Points:
- Contact children (siblings, cohabiting, or under same care) require thorough history and physical exam before imaging.
- Children under 12 months need neuroimaging (MRI preferred) and skeletal survey.
- Children 12-24 months require skeletal survey; those over 24 months need no routine imaging unless indicated.
Conclusions:
- Consensus recommendations provide a baseline for evaluating at-risk contact children.
- Standardized screening protocols improve detection of occult injuries.
- These guidelines empower clinicians to advocate for vulnerable children and prevent further abuse.
Importance:
Physical abuse is a common but preventable cause of long-term childhood morbidity and mortality. Despite the strong association between abuse in an index child and abuse in contact children, there is no guidance outlining how to screen the latter, significantly more vulnerable group, for abusive injuries. Consequently, the radiological assessment of contact children is often omitted, or variably performed, allowing occult injuries to go undetected and increasing the risk of further abuse.
Objective:
To report an evidence-based and consensus-derived set of best practices for the radiological screening of contact children in the context of suspected child physical abuse.
Evidence Review:
This consensus statement is supported by a systematic review of the literature and the clinical opinion of an internationally recognized group of 26 experts. The modified Delphi consensus process comprised 3 meetings of the International Consensus Group on Contact Screening in Suspected Child Physical Abuse held between February and June 2021.
Findings:
Contacts are defined as the asymptomatic siblings, cohabiting children, or children under the same care as an index child with suspected child physical abuse. All contact children should undergo a thorough physical examination and a history elicited prior to imaging. Contact children younger than 12 months should have neuroimaging, the preferred modality for which is magnetic resonance imaging, and skeletal survey. Contact children aged 12 to 24 months should undergo skeletal survey. No routine imaging is indicated in asymptomatic children older than 24 months. Follow-up skeletal survey with limited views should be performed if abnormal or equivocal at presentation. Contacts with positive findings should be investigated as an index child.
Conclusions And Relevance:
This Special Communication reports consensus recommendations for the radiological screening of contact children in the context of suspected child physical abuse, establishing a recognized baseline for the stringent evaluation of these at-risk children and providing clinicians with a more resilient platform from which to advocate for them.
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