Abuse

Question 1

signs: physical abuse

Answer 1

• fractures - any # in non-mobile child, rib fractures, multiple fractures (and of different ages)
• bruises - shape of hand, strangulation on neck, wrists/ankles for ligatures, buttocks
• burns - child non-mobile, shape of implement, glove or stocking burn (forced immersion)
• bites

Question 2

presentation: physcial abuse

Answer 2

consider:
* hx of child
* age and stage of development
* background - past attendances
* delay in presenting
* inconsistent hx from caregivers

Question 3

ix: physical abuse

Answer 3

• full skeletal survey and repeat in 1-2 weeks
• body map
• coagulation screen
• look for #, burns and scalds
• look for head and neck trauma (extradural = direct trauma, subdural = shaking)
• document findings

Question 4

things to rule out: physical ause

Answer 4

• coagulation disorder
• mongolian blue spots
• osteogenesis imperfecta (blue sclera and Wormian bones in skull sutures)

Question 5

presentation: sexual abuse

Answer 5

• child aware of things beyond their years
• pregnancy
• STI with no clear reason
• vaginal or rectal bleeding

Question 6

behavioural signs: sexual abuse

Answer 6

• soiling
• secondary enuresis
• self harm
• sexualised behaviours
• poor school performance

Question 7

ix: sexual abuse

Answer 7

• STI screening
• forensic swabs of body, clothing and bedding for semen

Question 8

signs of emotional abuse: babies

Answer 8

• apathetic
• delayed development
• non-demanding

Question 9

sings: emotional abuse in toddler/pre-school child

Answer 9

• violent
• apathetic
• fearful

Question 10

signs: emotional abuse in children

Answer 10

• wetting
• soiling
• relationship difficulties
• non-attendance
• anti-social behaviour

Question 11

signs: emotional abuse adolescents

Answer 11

• self-harm
• depression
• oppositional
• aggressive
• delinquent behaviour

Question 12

signs: neglect

Answer 12

• consistently misses medidcal appointments
• lacks needed medical/dental care or immunisations/lasses
• seems ravenously hungry
• dirty
• inadequate clothing

Question 13

induced illness: children

Answer 13

when parent (usually mother) causes harm to children
* multiple unexplained illnesses/admissions
* symptoms only occur in carers prescence
* not substantiated clinical findings

may involve:
* verbal fabricatin
* induction of illness - suffocation or poisoning

Question 14

rx: abuse

Answer 14

• injuries carefully noted, measured, recorded on body map and photographed
• if abuse suspected - decide if child needs immediate protection
• if treatment not necessary but home unsafe - foster home
• consider other siblings and their safety