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NMSK Exam 1 > 17. Child/Elder Abuse > Flashcards

17. Child/Elder Abuse Flashcards

1
Q

When a physician suspects child abuse, what is their primary role?

A
  1. REPORT; not investigate. If possible, separate child from adult for a PE to see if they share. Ask a couple of qs, stick with facts (not labels) and avoid accidenly leading into false memory.
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2
Q

RF for child to be abused?

A
  1. Factors that make caretaking difficult
    1. Fussy, colicky kid
    2. Hyperactive
    3. Ill
    4. Non-biologic relationship to caregiver
    5. Premature
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3
Q

RF to committing child abuse?

A
  1. Substance abuse
  2. Criminal
  3. Mental health hx
  4. Teen parents
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4
Q

Family/environmetal factors that are RF to child abuse

A
  1. Social isolation
  2. Intimate partner bviolence
  3. High unemployment rates; poverty
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5
Q

Definition of child abuse?

A
  • Recent act or failure to act that causes [death, serious physical/emotional harm, sexual abuse/exploitation or imminent risk of serious harm]; involves a child and done by parent/caregiver.
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6
Q

4 main types of child abuse

= indicate the most common and which is the most common cause of death

A
  1. Neglect * MC and MCC of death in abused kids
  2. Emotional
  3. Physical
  4. Sexual
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7
Q

What type of child abuse is the most common and MCC of death in abused chidren?

A

Neglect

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8
Q

What is neglect?

A
  • Failure to provide basic needs to child
    • physical (food, clothes, hypeine, protection, supercivsion)
    • emotional (love, security, emotional support)
    • Education (not in school)
    • Medical (not giving medical or dental care)
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9
Q

How should a doc perform a well-child visit to make sure they arent being neglected?

A

Check

  1. Nutrition
  2. Safety
  3. Developmental stages
  4. Dental/ eye recomendation
  5. Educational needs (are they going to school)
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10
Q

What should a doc do if they suspect neglect?

A
  1. Get a full medical Hx
  2. Psychosocial Hx
  3. Complete PE
  4. Make sure child is safe and contact CPS, even when in doubt!!! Check with attending before.
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11
Q

If diagnosis of neglect is NOT clear, what should the doc do?

A
  1. Arrange a home visit by a social worker/home nurse
  2. Arrange a well-check by local police force
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12
Q

Is emotional abuse easy to spot in practice?

A

No; it has to cause demonstratable harm to child

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13
Q

What behavior patterns may suggest emotional abuse?

A
  1. Withdrawal
  2. Angry/aggressive
  3. Eating disorders
  4. Failure to thrive
  5. Deve;opmental delays
  6. sleep disorders
  7. Hurt themselves

These are NOT result of abuse

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14
Q

What is the docs role when suspecting emotional abuse?

A
  1. If isolated incident and no immediate danger to child: recommend family therapy, parenting classes, supportive therapy or behavior therapy
  2. If recurrent and can harm child: report to CPS
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15
Q

What are suspicious signs of abuse on PE?

A
  1. Fractures to: Posterior rib, scapula, sternum
  2. Damage to SP
  3. Cigarrette burns
  4. Metaphyseal lesions
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16
Q

How to go about into asking about abuse/looking for?

A
  • look for
    • unsusual lesions/location
    • patterns of bruises
    • hanprints
    • stocking or glove burn
    • lesions of different healing stage
    • reported mechanisms not consistent with extent of injury
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17
Q

Actions you can take as a doc if you suspect abuse?

A
  1. Call CPS
  2. Meet separetly with caregiver and get info
  3. Document carefully
  4. Photograph injuries: downlad to a secure location
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18
Q

What is sexual abuse?

A

Employment, use, persuasion, inducemnt, enticement or coercion of any child to engage/help engage in sexual acity

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19
Q

What are the 3 types of sexual abuse?

A
  1. non touching
  2. touching
  3. exploitation
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20
Q

exampls of non-touching sexual abuse

A
  1. show kid porn
  2. neglectfully let kid see/hear sex
21
Q

sexual exploitation examples

A
  1. Child prostitution
  2. Use a child to film, photograph or model porn
  3. human trafficking
22
Q

Most victims of sexual abuse are…

A
  • 9 - 12 YO (60% F)
  • 50% of cases occur in family
23
Q

Are victims of sexual abuse liekly to report?

A

no; 50-70% never tell anyone

24
Q

male sexual abuse victimes are more likely to…

A
  1. cause teen PG
  2. Have many sex partenrs
  3. have unprotected sex
25
Q

Docs role when suspecting sexual abuse; is it likely to be seen on PE?

A
  1. ​Report to CPS!
  2. When there is sexual abuse, unlikely to see on PE
    1. HX = most important to document; use quotations!
    2. If dysuria, anal/vaginal bleedin, pain when poop = do PE ASAP
  3. Provide immediate emotional support
  4. If interview is needed, do a Minimal Facts Interview
26
Q

when doing a PE in a pre-pubertal child, what is important?

A

dont touch hymen and do not use speculum

27
Q

when evaluating sexual abuse..

A

no single behavior, sign or sx is diagnostic

28
Q

In sexual abuse, why is PE NL?

A
  1. Sexual abuse does not have to involve injury
  2. Perp wants to reuse victim and not get caught
  3. Delay in time between injury and seeing doc
29
Q

In sexual abuse cases, if immediate interview is neeeded, what do we do?

A

Minimal Facts Interview

  1. Ask who, what when where, how
    1. what happend to you
    2. what did he touch you with
    3. where did he touch you; where were you when this happen
30
Q

in minimal facts interview, what should you avoid asking?

A

avoid asking when; kids are bad with spatial timing.

Instead, ask “did this happen 1 or more than 1 time?

31
Q

Who is at high risk to being sexually abused?

A
  1. Deaf kids (50%)
  2. Transgender (50%)
  3. Develomentally disabiled adults (83% are F)
32
Q

Failure to report child abuse in Missouri is what type of misdemeanor?

A

Class A; provider-patient confidentiality does NOT apply.

33
Q

Failure to report child abuse in Kansas is what type of misdemeanor?

A

Class B misdeamor, EVEN when another mandated reporter has made a report.

ALL mandated reporters must report.

34
Q

Are medical students mandated reporters?

A

NO

35
Q

Is elder abuse often reported?

A

No; 80% is not.

36
Q

RF for elder abuse?

A
  1. Dementia/psychiatric diagnosis
  2. Physical dependence
  3. Incontinence
37
Q

RF for commiting Elder abuse

A
  1. Substance abuse
38
Q

What are the types of elder abuse?

which is most common>

A
  1. Physical abuse
  2. Sexual abuse
  3. Psychological abuse (threaten to put them in home, not give meds/food/water)
  4. Financial abuse
  5. Neglect (50%)
39
Q

Exaples of active/intentional neglect

A
  1. not giving basic needs/food, assistance
40
Q

Exaples of passive/unintentional neglect

A

Due to ignorance or inability of caretaker

41
Q

What types of bruises do we most commonly see in elder?

A
  • Bilateral; on inner arm from being grabbed.
  • On ST, NOT over bony prominence
42
Q

what type of fractures do we most commonly see in elderly?

A
  • Fractures at different stages of healing
  • Spiral fractures, from limbs being twisted
43
Q

Other signs of abuse in elderly

A
  1. Rope burns on wrist = from being tied up
  2. Injuries to mouth from force feeding
  3. No money bc family spent it.
44
Q

Common signs of elder abuse on PE

A
  1. Bruising/burns
  2. Unexplained injuries
  3. Findings of sexual abuse
45
Q

What should doc do if suspect elder abuse?

A
  1. Report to senior protective services (SPS)
  2. Document carefully: pics, XR, digram of injuries, written doc
46
Q

Age of senior citizen in Missouri

Not reporting elder abuse in Missouri results in?

A
  • 60+ (federal govt says 65+)
  • Class A misdemeanor (1 year in jail + 2000)
47
Q

Age of senior citizen in Kansas

Not reporting elder abuse in Kansas results in?

A
  • Call this number for 60+; and 18+ who cant proctect themselves
  • Class B misdeamor (6 months in jail + 1000)
48
Q
A

NMSK Exam 1 (22 decks)

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