Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Mental Health > Abuse - MH > Flashcards

Abuse - MH Flashcards

1
Q

Definition of Physical Abuse

A

Physical abuse is generally defined as “any non-accidental physical injury to the child” and can include striking, kicking, burning, or biting the child, or any action that results in a physical impairment of the child
Legal definition varies by state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk Factors

A
  1. 2% had a Disability
    - Mental Retardation
    - Emotional Disturbance
    - Behavioral Problems
    - Another Medical Problem – chronic

Domestic violence Exposure

  • 25.1% of victims
  • 8.2% of non-victims
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Types of Maltreatment

A

78.5%: Neglect
17.6%: Physical abuse
9.1%: Sexual abuse
8%: Emotional maltreatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Who Were the Victims?

A

Birth to 2 years: 27.1%
Younger than 9 years: 63%

Race

  • White: 44%
  • African American: 22%
  • Hispanic: 22%
  • Other, unclassified: 12%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Perpetrators

A

81% were parents
-4/5 child fatalities were caused by one or more parents
85% were 20-49 years
54% were women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Taking a History

A
  • Medical providers are not investigators
  • However, medical providers are often recording the first history
  • Take time to get a detailed history
  • Talk a little and listen a lot
  • Document description of injury in detail
  • Identify “players”
  • Use quotes when possible
  • Be sure that anything in quotes is actually a quote
  • Don’t skimp on the documentation
  • Skimpy documentation more, not less, likely to require testimony to clarify
  • Consider taking histories from each caregiver individually
  • Control information exchange
  • Information offered by health care providers may be woven into a false history
  • DO NOT OFFER POTENTIAL EXPLANATIONS
  • Did you squeeze him?
  • Did you shake him?
  • Avoid confrontation or accusation
  • Ask for details
  • What happened next?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Past Medical History

A
  • Should be a general review and focused on area of concern with documentation of pertinent negatives
  • Bone disease: history of fractures, prematurity, diet and vitamin D exposure, drugs
  • Bleeding: circumcision or surgeries, frequent bruises, diet, drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Family History

A
  • Include known diagnosis as well as symptoms suggestive of occult diagnosis (document absence of symptoms)
  • For example, hearing loss and poor dentition may suggest OI
  • Coagulation disorders may be familial and may be suggested by easy bruising or prolonged menses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Social History

A
  • Include history of domestic violence and CPS involvement
  • Use caution in relying too heavily on social history
  • Abuse occurs in all socioeconomic classes
  • Missed more frequently in higher SES
  • Medicine does not train us to identify “good” or “bad” people
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

History Red Flags

A
  • Developmentally inappropriate histories
  • No history—particularly in very young infants
  • Histories inconsistent with injuries
  • Short falls resulting in serious injuries
  • Serious injuries inflicted by small children
  • Delay in seeking medical care
  • Changing history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Commonly provided histories for serious injury/death that should raise the concern for child maltreatment

A
  • Child fell from low height
  • Child fell onto furniture, floor, or object
  • Child unexpectedly found dead
  • Child choked; shaken to dislodge object
  • Child turned blue; shaken to revive
  • Child experienced sudden seizure activity
  • Resuscitation efforts caused injuries
  • Caused by traumatic event a day or more prior
  • Adult tripped or slipped while carrying child
  • Child’s sibling injured the child
  • Child left alone for short time
  • Child fell down stairs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Falls

A
  • The leading cause of nonfatal injuries for all children
  • Rarely cause fatal injury in children
  • a morality rate of 0.48 cases per 1 million children for short falls in children under 5 yrs
  • Very common history in abused children
  • Falls are common
  • Falls most often result in no injury
  • Serious injury or death from short falls is reported but is exceedingly rare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Physical Exam Considerations

A
  • Head: External marks, bruises under hair
  • Intraoral: Frenum tears, dental trauma, -tongue lesions
  • Neck: Bruises, strangulation marks
  • Ears: Bruises of pinna, hemotympanum
  • Eyes: Bruises around eyes, retina
  • Chest: Grab marks, tender areas, bruises
  • Abdomen: Distention, tenderness, bruises
  • Ano-genital: Bruises, tissue damage of female genitalia, anal trauma, scrotal hematoma, penile lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bruises

A

-Common manifestation of physical abuse
Keys to diagnosis
-Child’s development
-Location
-Pattern
-Accidental bruises – bony prominences: shins, elbows, lower arms, forehead, underneath chin, ankles, hips
-abuse bruises: upper anterior thighs, trunk (torso, chest, back), upper arms, face and ears, hands and feet, buttocks and anus, genitalia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Age/Development

A
  • Bruising is rare in infants/pre-cruisers and becomes increasingly more common as children age and develop
  • If bruising is seen in a non-ambulatory child, consideration should be given to abuse or some other underlying condition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pattern Injuries

A

Patterned injury (of any type) should significantly heighten the concern for an abusive etiology over an accidental one

  • Slap marks
  • Loop or elliptical marks
  • Linear marks
  • Vertical bruising on the buttocks
  • Objects
17
Q

Skeletal Injuries

A
  • All cases with fractures require a comprehensive history and physical examination, including details of the event and developmental history
  • Accidental vs abusive etiology is rarely made based on the type of fracture
  • Location, however, can provide important information in making this determination

High specificity for abuse

  • Metaphyseal lesions
  • Posterior rib fractures
  • Scapular fractures (rare)
  • Spinous process fractures (rare)
  • Sternal fractures (rare)

Moderate specificity for abuse

  • Multiple fractures, especially bilateral
  • Fractures of differing ages
  • Epiphyseal separations
  • Vertebral body fractures
  • Digital fractures
  • Complex skull fractures

Low specificity for abuse

  • Clavicular fractures
  • Long bone shaft fractures
  • Linear skull fractures
18
Q

Head Injury

A
  • The large size of children’s heads relative to their bodies causes the head to be a frequent site of injury, accidental and inflicted
  • Certain injuries (subgaleal hemorrhage or epidural hematoma) are more commonly associated with accidental injury
  • Both accident and abuse can cause intracranial injury, complicating the diagnosis

Factors more commonly associated with abusive head injury

  • Young age (<1 year)
  • Lack of history of a significant traumatic event
  • Changing history from the caregiver
  • Presence of head injury symptoms/seizures at presentation
  • Poor outcomes
  • Report that home resuscitation caused the injury
19
Q

Subgaleal Heamtoma

A
  • May occur from traumatic hair-pulling
  • Detailed birth history is necessary for young infants, as newborns may have the same findings as the result of an instrumented delivery
20
Q

Scalp Bruising

A
  • Simple bruising is expected in ambulatory children over the bony prominences, including the forehead
  • More extensive bruising of the scalp, especially in the setting of additional injury, should heighten concerns of abuse
21
Q

Epidural Hemorrhage

A
  • Epidural hematomas in children are often from accidental mechanisms
  • However, as with all childhood injuries, differentiation of accidental from abusive etiologies requires careful analysis of the history provided and the injuries sustained
22
Q

Subdural Hematoma

A
  • Although these bleeds may result from accidental mechanisms, in infants and young children abusive mechanisms more commonly account for subdurals than epidurals
  • Subdurals are the most common cranial radiographic abnormality in child abuse
23
Q

Head Injury

A
  • Evaluation requires comprehensive history and physical examination, consideration of injury biomechanics, epidemiology of childhood injury, a thorough search for occult injury, and a careful investigation into the cause of injury for each child
  • The medical literature supports the conclusion that severe head injuries, unless related to a motor vehicle accident or a fall from a significant height, are likely to be the result of abuse
24
Q

Visceral Injury

A

-Blunt abdominal trauma is a relatively rare form of child abuse, but is the second most common cause of death from child abuse

Factors associated with abuse

  • Increased severity of injury
  • Multiple injuries
  • Delay in seeking care

Mental Health (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions