Misdiagnosis of abuse

Health care professionals are mandated by law to report suspected cases of child abuse. However, such a report is not a diagnosis or an accusation. Additional investigation by a child welfare agency will help to determine whether abuse or neglect is a concern. More reports of suspected abuse should be investigated than the number of cases of actual abuse that are found, just as more lumps will be investigated than turn out to be cancer and more coughs than turn out to be pneumonia. When abuse is suspected, evaluation by a child abuse and neglect team, along with a careful pediatric examination, rarely results in misdiagnosis (in less than 1% of cases).2 In contrast, early studies of abused children discharged to their parents without any intervention indicated that 25% are seriously reinsured and 5% are subsequently killed.3 I next saw the child at 10 months of age during a day visit to the birth mother. The presenting problem at that time was described as recurrent impetigo of the left pinna. Infected eczema of the left pinna had been diagnosed on several occasions in the intervening period, and a dermatologist had confirmed the diagnosis of impetigo. This story sounded odd and led me to speculate that the child might have a herpes simplex infection. The dermatologist had taken a sample for culture, and a phone call to the local laboratory confirmed that the viral swab was growing herpes simplex I. In view of this information, I suspected that the episodes of ecchymosis of the left pinna seen in the first few months of life were actually the result of the original herpes infection.