NEW YORK (Reuters Health) Sept 11 - Any intentional skin injury in pediatric patients, beyond temporary reddening, should alert physicians to child abuse, according to a report by the Committee on Child Abuse and Neglect of the American Academy of Pediatrics.

"Injuries to the skin, including minor bruises that are determined not to be accidental should be considered abuse," committee chairperson, Dr. Steven W. Kairys from Jersey Shore Medical Center, Neptune, New Jersey, told Reuters Health.

Dr. Kairys said that the problem is that the definition of abuse seems to have eroded over time. "Many states are so inundated with reports that they have set the bar too high on which cases to investigate. State courts have also failed to understand the significance of nonaccidental bruises," he said.

There are three factors that are of concern, Dr. Kairys said. "First, a child who is abused by, lets say, being thrown down, could, depending on the environmental circumstance, have a head injury, a broken bone, or only a bruise. The intent and the abuse are the same."

Second, children who are abused and not protected will often wind up with much more significant injury later on. "And third, the physical injuries are only an external manifestation of chronic psychological abuse and terror," he explained.

"The injury is the way that the family dysfunction is finally brought to light. To ignore it is to fail to understand the deeper and very concerning trauma to the child's psyche and the child's soul," Dr. Kairys said.

In their report in the September 3rd issue of Pediatrics, the Committee offers five recommendations.

First, pediatricians must recognize nonaccidental injuries as abuse and, second, abuse should be considered the most likely explanation for inflicted skin injuries.

Third, they urge legislatures not to adopt laws that "create nonmedical definitions as to what constitutes nonaccidental inflicted skin injuries," and to repeal any such existing laws.

Fourth, pediatricians should work with state legislatures and social service agencies to ensure that this policy is implemented, and fifth, "pediatricians should counsel or provide appropriate referral to assist caregivers with appropriate behavior management of children."

Pediatrics 2002;110:644-645.