Nonaccidental trauma in children: the pediatrician's role in recognition, reporting, and prevention

Nonaccidental trauma remains a significant and underrecognized contributor to pediatric injury and mortality, reflecting both clinical and societal challenges in prevention and early identification. This review aims to synthesize the most recent literature on pediatric nonaccidental trauma (NAT) to better equip members of the healthcare team, particularly those in direct patient care, such as physicians, with the insight, contextual awareness, and ethical vigilance needed to identify, manage, and intervene in cases of child maltreatment. In doing so, it highlights the critical role of the healthcare team in not only treating injury but also protecting vulnerable children and addressing the broader implications of abuse.

Recent literature highlights specific types of cutaneous injury, including patterned bruising and scald burns as well as high-energy osseous fractures such as those involving the femur, skull, face, ribs, or sternum, particularly when accompanied by an incongruent history, as the strongest indicators of NAT.

Nonaccidental trauma is often difficult to identify on both historical and clinical levels. Guardians, typically the abusers, may be evasive and may offer accounts that are inconsistent or incompatible with the presenting injury. Identifying nonaccidental trauma calls for heightened vigilance and a high index of suspicion in providers, as their proximal position affords them the responsibility to be a crucial lifeline.