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Treatment and Follow-up : Physical Abuse

When treating children/adolescents who have been physically abused, evaluate the social, emotional, and physical status. Ensuring the safety of the child/adolescent is critical to treatment and should be a priority.

Hospitalization

Children may require hospitalization based on the severity of their injuries. Safety concerns may also necessitate hospitalization if it is unsafe for the child to return home. Report any suspicious injuries to the NYS State Central Register at 1-800-635-1522 or your local hotline if that has not already been done. For more information, see: Child Welfare Information Gateway - State Statutes Search

Head Injury Treatment

  • Head injuries are the leading cause of death in abused children.
  • Severe head injury with symptoms like vomiting, lethargy, irritability, increasing head size, unresponsiveness, or visible head trauma requires immediate intervention.
  • Treatment may need to occur in an intensive care unit with neurosurgical evaluation and possible surgery.

Burn Treatment

Depending on the severity, burns may require rehydration and wound care. For severe burns, this would typically occur in a burn or surgical ICU.

Treatment of Bruises and Fractures

  • Bruises and fractures should be treated to manage pain and bleeding.
  • For fractures in children, consult an orthopedic specialist with pediatric expertise.

Excessive Corporal Punishment

The New York State Child Abuse and Maltreatment Law distinguishes excessive corporal punishment as a form of maltreatment. For more information, see: New York State Laws - Social Services Law - SOS § 412 .

In practice, “excessive” corporal punishment generally means any physical discipline that:

  • Leaves marks or injuries (e.g., bruises, welts, burns)
  • Is disproportionate to the behavior (e.g., hitting a child multiple times for a minor infraction)
  • Involves dangerous methods (e.g., using objects like belts, cords, or hitting the child in the face or head)
  • Is administered in anger or loss of control, increasing risk of harm
  • Occurs repeatedly, indicating a pattern of abusive behavior

Treatment for excessive corporal punishment involves a comprehensive evaluation for physical and mental health harm and impact and ensuring safety of the child, as would be performed for all types of physical abuse. In addition, the medical professional should consider these steps:

Interventions with the Caregiver

  • Parenting education focused on non-violent discipline strategies and child development.
  • Mental health or substance use treatment if contributing factors are identified.
  • Domestic violence services, if relevant.
  • Court-ordered services, in some cases, if the abuse is part of a CPS investigation or legal case.

For more information, see: Sege RD, Siegel BS. Effective Discipline to Raise Healthy Children. Pediatrics. 2018; 142 (6). (DOI) .

National Child Traumatic Stress Network - Understanding child physical abuse. (n.d.).

Ongoing Monitoring

Follow-up visits by CPS or healthcare providers to assess progress and safety. If the child was removed, reassessment of family dynamics to determine when or if reunification with the family is appropriate.

Follow-Up of Physical Abuse

Primary care clinicians play a vital role in the ongoing care of children involved in child protective services (CPS) due to suspected physical abuse. Even after CPS involvement ends, these children often continue to receive care in their medical home, where pediatricians are uniquely positioned to monitor recovery, detect new concerns, and support healthy development. Most of the suggestions below also apply to children who were sexually abused, neglected or maltreated.

The primary goal is to assure that the child suffers no further harm. Close continuity of care with the child/adolescent and family may help to ensure support for the non-offending caregiver. However, it is not a substitute for reporting to child protective services. Remain a strong advocate for the child and family. This includes offering or referring for supportive services, ongoing mental health intervention, and further medical follow-up.

Recommended Follow-Up Schedule

Frequent monitoring
Monitoring by the primary care office is essential, especially in the first few months. For example, scheduling an initial follow-up within 1 week of returning home from a hospitalization. Subsequent visits may be adjusted based on age, developmental needs, and family circumstances.
Follow-up skeletal survey
If an initial skeletal survey was obtained as part of the evaluation for fractures and abuse in a child who is 2 years old or younger, a follow-up skeletal survey is recommended to be performed 2 weeks after the initial evaluation.
Other follow-up radiographic studies
Depending on initial findings, MRIs, selective bone images, or other testing may be necessary.
Follow-up laboratory studies
It is not common to require follow-up testing unless abnormalities were identified on initial testing, such as anemia, abnormal electrolytes, or elevated liver function tests.
Key Areas to Monitor
Medical history and documentation
Understand the reason for CPS involvement and track any new injuries.
Communication with CPS
With consent, coordinate care and clarify follow-up needs.
Cultural and placement history
Assess if the child’s placement environment was culturally unfamiliar and how that affected adjustment.
Behavioral and emotional health
Ask about emotional or behavioral changes and speak privately with older children when possible.
Environmental risks
Screen for hazards like lead or tobacco exposure, especially after placement changes.
Adolescents
Use tools like HEEADSSS (Doukrou M, Segal TY. Fifteen-minute consultation: Communicating with young people-how to use HEEADSSS, a psychosocial interview for adolescents. Archives of Disease in Childhood. Education and Practice Edition. 2018; 103 (1) : 15-19. (DOI) .) to assess risk-taking behaviors and mental health. Encourage HPV vaccination.
Development and academics
Screen for developmental delays and academic challenges after all forms of abuse and especially after neglect or head trauma. For children with head injuries, consider comprehensive developmental assessments and referrals to a Pediatric Developmental Specialist, Early Intervention Programs, or school-based evaluations.
Hearing screening and eye examinations
Infants with head trauma should be evaluated by an ophthalmologist for signs of retinal hemorrhages. Subsequent follow-up eye exams may be recommended, depending on the findings. Infants and children post-head trauma should have at least one follow-up hearing evaluation.
Growth and nutrition
Monitor for failure to thrive, obesity, or signs of nutritional neglect.
  • Skin, oral, and physical health: Conduct thorough, unclothed exams to identify signs of injury or neglect. Refer to dental care when appropriate.
  • Sexual development: Be sensitive to abnormal puberty patterns; screen for STIs if indicated.
  • Abusive head trauma (AHT): Monitor closely for neurologic, visual, or developmental delays. Consult neurology or endocrinology when needed.

For more information, see: Bennett CE, Christian CW. Clinical evaluation and management of children with suspected physical abuse. Pediatric Radiology. 2021; 51 (6) : 853-860. (DOI) .

Flaherty E, Legano L, Idzerda S. Ongoing Pediatric Health Care for the Child Who Has Been Maltreated. Pediatrics. 2019; 143 (4). (DOI) .

Support for Families and Caregivers

Support for Families and Caregivers

  • Observe parent-child interactions and explore their response to CPS involvement.
  • Screen for stressors like food insecurity, caregiver depression, or inappropriate discipline.
  • Encourage positive parenting and emotional support systems.
  • Guide families toward available community services and parenting programs. For a sample list, see Appendix [I] [NEED LINK]

Prevention of Recurrence

  • Be alert for signs of ongoing or new abuse, especially if the child is placed back into the same home environment.
  • Report new concerns based on reasonable suspicion, even if a child is no longer under CPS supervision.
  • Encourage families to complete recommended services to reduce risk of recurrence.

Advocacy and Collaboration

Physical Abuse

Treatment and Follow-up