About This Page
This is a clinician-written, evidence-based guide aligned to the MCC Examination Objectives. It is structured by clinical presentation — the way the MCCQE tests and the way patients actually present. Management reflects current Canadian guidelines (CMA, CFPC, CPS). Always cross-reference with institutional protocols and clinical judgment.
The Bottom Line
- Reasonable suspicion of child abuse or neglect must be reported promptly to child protection; proof is not required
- Immediate safety and medical care come first: treat injuries, assess danger, involve senior/paediatric/social work teams, document objectively
- Elder abuse requires capacity-sensitive assessment; capable adults may decline intervention, but reporting varies by setting/jurisdiction
- Abuse includes physical, sexual, emotional, neglect, medical neglect, financial exploitation, and coercive control
- Document verbatim statements, body maps/photos per policy, objective findings, developmental consistency, who was present, and reporting details
Approach to the Presentation
Abuse scenarios test recognition, mandatory reporting, confidentiality exceptions, capacity, and safety planning. In child maltreatment, report reasonable grounds immediately and directly. Do not confront a perpetrator in a way that increases danger or attempt a full forensic investigation. In elder abuse, assess danger, capacity, dependency, coercion, caregiver stress, neglect, and local reporting duties.
Differential Diagnosis
| diagnosis | likelihood | key features | distinguishing test |
|---|---|---|---|
| Physical child abuse | must-not-miss | Injury inconsistent with history/development, patterned bruises/burns/fractures, delay, changing story | Full exam, skeletal survey if indicated, report |
| Sexual abuse/exploitation | must-not-miss | Disclosure, genital/anal symptoms, STI, pregnancy, behavioural change, online grooming | Specialised team, STI/pregnancy testing, forensic pathway, report |
| Neglect/medical neglect | must-not-miss | Failure to provide food, shelter, supervision, medication, urgent care | Assess harm/risk and report when child at risk |
| Abusive head trauma | must-not-miss | Infant vomiting, seizures, lethargy, apnea, bulging fontanelle, retinal haemorrhages, subdural | Stabilise, neuroimaging, ophthalmology, paediatrics, child protection |
| Elder abuse | must-not-miss | Bruises, fear, controlling caregiver, missing money, medication withholding, isolation, pressure ulcers | Private interview, capacity assessment, safety plan, social work/reporting |
| Elder neglect/self-neglect | common | Poor nutrition/hygiene, unsafe home, falls, cognitive impairment, caregiver burnout | Capacity, supports, home care, reporting if required |
| IPV affecting child/elder | common | Children exposed to domestic violence or elder dependent on abusive partner | Safety assessment and reporting if child at risk |
| Accidental injury | common | Developmentally plausible mechanism and consistent history | Document and reassess if inconsistencies arise |
| Mimic of abuse | less common | Bleeding disorder, OI, dermal melanocytosis, dermatologic lesions | Medical workup but do not delay reporting if suspicion |
Red Flags & Key History
Symptoms
Bruising in non-mobile infant or patterned injury
Delay in care or inconsistent history
Disclosure of sexual abuse, coercion, exploitation, trafficking
Child deteriorating due to omitted care
Older adult afraid of caregiver or cannot speak privately
Caregiver stress without current harm
Accidental injury with consistent history
Signs
Multiple injuries at different stages, burns, fractures, malnutrition, pressure ulcers
Child fearful of going home or caregiver blocks private interview
Elder cognitive impairment, dependency, injuries, missing meds, financial control
Developmentally plausible mechanism
Safe caregiver willing to engage
Approach to Assessment
First-line
Immediate safety/stabilityTreat injuries, pain, dehydration, infection, sexual assault needs, mental health crisis
Private trauma-informed historyOpen questions; avoid leading; document verbatim
Objective exam/documentationFull exam, body map, photos per policy, growth, development, mental status
Report child suspicionCall child protection promptly; document time/person/advice
Second-line
Child maltreatment workupSkeletal survey, head imaging, ophthalmology, CBC/coags, enzymes, urinalysis, STI/pregnancy testing as indicated
Elder abuse assessmentCapacity, cognition, dependency, finances, medications, home safety, supports
Safety planningSocial work, shelter, adult protection, police, community supports
Specialist
Child protection/child maltreatment teamSuspected abuse/neglect, sexual abuse, abusive head trauma, unsafe discharge
Geriatrics/psychiatry/legal/adult protectionElder abuse with incapacity, severe neglect, exploitation, reporting uncertainty
Police/sexual assault teamImmediate danger, assault, forensic evidence, trafficking, criminal risk
Management Principles
CMPA child abuse reporting guidance + Canadian Paediatric Society child maltreatment guidance1
Suspected child abuse
- Treat urgent problems and ensure safe disposition
- Report reasonable suspicion promptly
- Explain duty to report when safe
- Document objectively and verbatim
2
Suspected elder abuse
- Assess danger, capacity, cognition, dependency, coercion
- Respect capable older adult autonomy while offering supports
- Know jurisdictional duties
- If incapable/serious risk, involve SDM/adult protection/police
3
Communication
- Use trauma-informed language
- Use professional interpreters
- Explain confidentiality limits
4
Follow-up
- Arrange paediatrics/geriatrics/social work/mental health/sexual assault/home care
- Do not abandon after reporting
Complications & Pitfalls
- Waiting for proof: child protection reporting needs reasonable suspicion.
- Leading questions: use open questions and exact words.
- Unsafe discharge: do not send patient back to danger.
- Elder autonomy: capacity and coercion matter.
- Stereotyping: assess harm respectfully.
MCCQE1 Exam Tips
- 1Report reasonable suspicion of child abuse immediately
- 2Bruising in a non-mobile infant is abuse until proven otherwise in exam logic
- 3Use verbatim quotes and objective descriptions
- 4Elder abuse reporting varies by jurisdiction and setting
- 5If elder lacks capacity or is in danger, involve adult protection/police/SDM
- 6Do not use suspected abuser as interpreter
- 7CanMEDS Health Advocate and Professional are central
practicetest your knowledge on child abuse & elder abuse — recognition & reportingApply what you've learnt with MCCQE1-style questions from the iatroX Q-Bank — ethics & communication and beyond.
open q-bank