17. Child/Elder Abuse Flashcards
When a physician suspects child abuse, what is their primary role?
- 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.
RF for child to be abused?
- Factors that make caretaking difficult
- Fussy, colicky kid
- Hyperactive
- Ill
- Non-biologic relationship to caregiver
- Premature
RF to committing child abuse?
- Substance abuse
- Criminal
- Mental health hx
- Teen parents
Family/environmetal factors that are RF to child abuse
- Social isolation
- Intimate partner bviolence
- High unemployment rates; poverty
Definition of child abuse?
- 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.
4 main types of child abuse
= indicate the most common and which is the most common cause of death
- Neglect * MC and MCC of death in abused kids
- Emotional
- Physical
- Sexual
What type of child abuse is the most common and MCC of death in abused chidren?
Neglect
What is neglect?
- 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)
How should a doc perform a well-child visit to make sure they arent being neglected?
Check
- Nutrition
- Safety
- Developmental stages
- Dental/ eye recomendation
- Educational needs (are they going to school)
What should a doc do if they suspect neglect?
- Get a full medical Hx
- Psychosocial Hx
- Complete PE
- Make sure child is safe and contact CPS, even when in doubt!!! Check with attending before.
If diagnosis of neglect is NOT clear, what should the doc do?
- Arrange a home visit by a social worker/home nurse
- Arrange a well-check by local police force
Is emotional abuse easy to spot in practice?
No; it has to cause demonstratable harm to child
What behavior patterns may suggest emotional abuse?
- Withdrawal
- Angry/aggressive
- Eating disorders
- Failure to thrive
- Deve;opmental delays
- sleep disorders
- Hurt themselves
These are NOT result of abuse
What is the docs role when suspecting emotional abuse?
- If isolated incident and no immediate danger to child: recommend family therapy, parenting classes, supportive therapy or behavior therapy
- If recurrent and can harm child: report to CPS
What are suspicious signs of abuse on PE?
- Fractures to: Posterior rib, scapula, sternum
- Damage to SP
- Cigarrette burns
- Metaphyseal lesions
How to go about into asking about abuse/looking for?
- 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
Actions you can take as a doc if you suspect abuse?
- Call CPS
- Meet separetly with caregiver and get info
- Document carefully
- Photograph injuries: downlad to a secure location
What is sexual abuse?
Employment, use, persuasion, inducemnt, enticement or coercion of any child to engage/help engage in sexual acity
What are the 3 types of sexual abuse?
- non touching
- touching
- exploitation
exampls of non-touching sexual abuse
- show kid porn
- neglectfully let kid see/hear sex
sexual exploitation examples
- Child prostitution
- Use a child to film, photograph or model porn
- human trafficking
Most victims of sexual abuse are…
- 9 - 12 YO (60% F)
- 50% of cases occur in family
Are victims of sexual abuse liekly to report?
no; 50-70% never tell anyone
male sexual abuse victimes are more likely to…
- cause teen PG
- Have many sex partenrs
- have unprotected sex
Docs role when suspecting sexual abuse; is it likely to be seen on PE?
- Report to CPS!
- When there is sexual abuse, unlikely to see on PE
- HX = most important to document; use quotations!
- If dysuria, anal/vaginal bleedin, pain when poop = do PE ASAP
- Provide immediate emotional support
- If interview is needed, do a Minimal Facts Interview
when doing a PE in a pre-pubertal child, what is important?
dont touch hymen and do not use speculum
when evaluating sexual abuse..
no single behavior, sign or sx is diagnostic
In sexual abuse, why is PE NL?
- Sexual abuse does not have to involve injury
- Perp wants to reuse victim and not get caught
- Delay in time between injury and seeing doc
In sexual abuse cases, if immediate interview is neeeded, what do we do?
Minimal Facts Interview
- Ask who, what when where, how
- what happend to you
- what did he touch you with
- where did he touch you; where were you when this happen
in minimal facts interview, what should you avoid asking?
avoid asking when; kids are bad with spatial timing.
Instead, ask “did this happen 1 or more than 1 time?
Who is at high risk to being sexually abused?
- Deaf kids (50%)
- Transgender (50%)
- Develomentally disabiled adults (83% are F)
Failure to report child abuse in Missouri is what type of misdemeanor?
Class A; provider-patient confidentiality does NOT apply.
Failure to report child abuse in Kansas is what type of misdemeanor?
Class B misdeamor, EVEN when another mandated reporter has made a report.
ALL mandated reporters must report.
Are medical students mandated reporters?
NO
Is elder abuse often reported?
No; 80% is not.
RF for elder abuse?
- Dementia/psychiatric diagnosis
- Physical dependence
- Incontinence
RF for commiting Elder abuse
- Substance abuse
What are the types of elder abuse?
which is most common>
- Physical abuse
- Sexual abuse
- Psychological abuse (threaten to put them in home, not give meds/food/water)
- Financial abuse
- Neglect (50%)
Exaples of active/intentional neglect
- not giving basic needs/food, assistance
Exaples of passive/unintentional neglect
Due to ignorance or inability of caretaker
What types of bruises do we most commonly see in elder?
- Bilateral; on inner arm from being grabbed.
- On ST, NOT over bony prominence
what type of fractures do we most commonly see in elderly?
- Fractures at different stages of healing
- Spiral fractures, from limbs being twisted
Other signs of abuse in elderly
- Rope burns on wrist = from being tied up
- Injuries to mouth from force feeding
- No money bc family spent it.
Common signs of elder abuse on PE
- Bruising/burns
- Unexplained injuries
- Findings of sexual abuse
What should doc do if suspect elder abuse?
- Report to senior protective services (SPS)
- Document carefully: pics, XR, digram of injuries, written doc
Age of senior citizen in Missouri
Not reporting elder abuse in Missouri results in?
- 60+ (federal govt says 65+)
- Class A misdemeanor (1 year in jail + 2000)
Age of senior citizen in Kansas
Not reporting elder abuse in Kansas results in?
- Call this number for 60+; and 18+ who cant proctect themselves
- Class B misdeamor (6 months in jail + 1000)
