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Injuries in Children Undergoing Subspecialty Abuse Evaluations Because of Intimate Partner Violence

M Katherine Henry1,2,3,4,5, Gunjan Tiyyagura6,7, Joanne N Wood1,2,3,5,8

  • 1Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Pediatrics Open Science
|July 29, 2026
PubMed

Insights

Skeletal surveys (SSs) are recommended for children under 24 months exposed to intimate partner violence (IPV). Physical exam findings increased fracture detection rates, but neuroimaging use varied by race/ethnicity and insurance.

Area of Science:

  • Pediatrics
  • Child Abuse Research
  • Radiology

Background:

  • Intimate partner violence (IPV) frequently co-occurs with child physical abuse.
  • The frequency and risk factors for abusive injuries in IPV-exposed children are not well understood.
  • Children under 24 months are particularly vulnerable to abusive injuries.

Purpose of the Study:

  • To determine the frequency and diagnostic value of skeletal surveys (SSs) and neuroimaging in children under 24 months with IPV exposure.
  • To identify factors associated with the use and positive findings of SSs and neuroimaging in this population.

Main Methods:

  • Retrospective study of children under 24 months evaluated by a child abuse pediatrics specialist (CAP) for IPV exposure.
  • Analysis of SS and neuroimaging use, diagnostic yield, and associations with sociodemographic and clinical factors.
  • Multicenter child abuse research network data from February 2021 to February 2024.

Main Results:

  • 93.6% of children underwent SSs, with 9.5% revealing new fractures.
  • 41.2% of children without head trauma symptoms underwent neuroimaging, with 6.4% showing intracranial injury.
  • Physical examination findings were associated with higher rates of newly identified fractures (15.7% vs 6.4%).

Conclusions:

  • Skeletal surveys are supported for medical evaluations of children under 24 months exposed to IPV.
  • Further research with larger sample sizes is needed to identify risk factors for positive imaging findings.
  • Neuroimaging use showed disparities related to race/ethnicity and insurance type.
Abstract

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