A retrospective analysis of differential diagnoses in cases of suspected child abuse Child abuse, no doubt-or not?

Background The diagnosis of non-accidental trauma or child abuse can lead to errors in both directions: either child abuse can go undetected or child abuse can be wrongfully diagnosed, if other differential diagnoses were not correctly taken into account. Such diagnostic errors can lead to continued child abuse in the home setting, or that the child is removed from the family without reason and the parents are falsely accused of child abuse. Methods Cases of child abuse from the last 10 years were retrospectively reviewed in order to identify false positive cases. The study and publication were reviewed and approved by the ethics committee of the Ludwig-Maximilians-University Munich. Results The cases where child abuse was wrongfully suspected had final diagnoses such as osteogenesis imperfecta type 6, lichen sclerosus, and hemophilia B. In all cases, local child protective services were involved, and in some cases the family court. In one case, the child was temporarily removed from the family. Discussion The child protection team can review necessary differential diagnoses and coordinate the collaboration with the local child protective services, the police, and the family courts. Removing a child from the family can be an effective measure to protect the child from further abuse in the case that abuse actually happened but unjustified placement in a foster family, even temporarily, must be avoided by all means, as this measure may unnecessarily traumatize children and parents. Consultation with forensic medicine may be helpful to establish the correct diagnosis.