Maryland CHAMP

The Maryland Child Abuse Medical Providers' Network

When concerns of child abuse arise, medical professionals may request tests to rule out certain medical conditions, as well as to evaluate possible child abuse. Below are brief descriptions of commonly ordered tests. 

Skeletal survey 
A skeletal survey is an x-ray of all of the bones, head to toe. This test is typically only ordered for babies and toddlers. A skeletal survey helps clarify whether there are any fractures (or broken bones) as well as the type and age of a fracture. The test is also helpful when it shows that there are no broken bones.  Sometimes the test may show problems or diseases that can cause weakened bones that break easily.
Sometimes, there is a lag period before fractures can be seen on x-ray. Therefore, at times a second (or “follow up”) skeletal survey will be ordered. 
CT (or CAT) scan of the head 
If there is concern that a child has a head injury, a head CT is likely ordered. This test provides information on bleeding in or around the brain and if the brain is swollen. 
Head MRI (Magnetic Resonance Imaging)
An MRI offers a more refined picture of the brain than does the CT scan. For example, it can detect small areas of bleeding and injuries. 
CT of the abdomen and/or chest
This test may be done to look for injuries to organs in the abdomen (belly) or chest.  Sometimes it is done after blood or urine tests indicate possible injury.  Other times, the test may be done because a child’s symptoms or findings on the doctor’s exam make him/her worry about chest or abdominal injury.  Children who have this test are usually asked to drink a white liquid called ‘contrast’ before the test.  This helps doctors see some organs better.
Ultrasound of the abdomen
This test uses sound waves to identify possible injuries to the belly.  It is the same type of test that is used to see the fetus (developing baby) in a pregnant woman.  Ultrasound can often be done more quickly than a CT scan, but it is not always as accurate.
Eye exam 
An eye exam is often ordered in young children (usually less than 2 years old). Dilating a baby’s pupils allows the eye doctor to check for signs of bleeding in the back of the eye (retinal hemorrhages) as well as other signs of trauma. 
Abdominal trauma panel (blood, urine) 
Blood and urine tests can demonstrate if there has been trauma to the belly (abdominal) area. The blood tests are enzymes of the liver and pancreas; these are elevated when these organs are injured. The urine test is for possible blood, often a sign of trauma. Sometimes a stool sample is collected to look for bleeding from the stomach or intestines.  A CT scan or MRI of the belly is often ordered if any of these tests indicate possible injury to abdominal organs. 
Tests for possible bleeding (or coagulation)  problems (blood)
In evaluating possible child abuse, it is always important to rule out possible medical conditions. Often, when a child presents with bruising, blood tests will be ordered to determine if the child has a medical condition that makes him or her susceptible to easy bruising or bleeding. 
Urine toxicology screen (urine)
This tests evaluates possible exposure to a variety of drugs and other substances.
Adapted from Dubowitz, H., & DePanfilis, D. (Eds.). (2000). Handbook for child protection practice. Thousand Oaks, CA: SAGE Publications, Inc