Radiological features of child maltreatment

Child maltreatment is serious, highly prevalent and topical. Approximately 1% of children are neglected or psychologically maltreated and 4%–16% are physically abused each year.Once child abuse is suspected, the radiological investigation must include a full skeletal survey and a computed tomography or magnetic resonance imaging brain scan. These should be followed by a repeat chest radiograph 10–14 days later. The radiological investigation is not complete without the follow-up chest radiograph.While no single injury is in itself diagnostic, there are certain findings that prompt the radiologist to suspect abuse. These include multiple fractures of varying age, long bone fractures in a non-ambulant infant, unexplained injuries, an explanation incompatible with the identified injury, multiple and differing explanations for the same injury, and certain fractures rarely seen in infants and young children except following major trauma (e.g. spine, scapula, pelvis).The role of the radiologist is to offer a mechanism for the identified injury, to date the injury and to exclude underlying skeletal or metabolic disease.The radiologist does not work in isolation, and close collaboration is required between radiologists, paediatricians, geneticists, pathologists, etc. in order that a correct and timely diagnosis is reached.