Abuse & Neglect Flashcards
What are the types of abuse?
Physical Emotional Neglect Sexual Exploitation Ficticious
How is physical abuse defined?
Any child who receives physical injury Or omission of prevention By parents/guardians Includes: Actual, likely physical harm, failure to prevent physical harm Deliberate poisoning, suffocation, FII
How is emotional abuse defined?
Failure to provide a developmentally appropriate, supportive environment so child can develop stable & full range of emotions
How is neglect defined?
Failure to provide for the development of the child:
Health, education, emotional development, nutrition, shelter, safe living conditions
How is sexual abuse defined?
Involvement of a child in sexual activity that he/she does not fully comprehend
Unable to give informed consent to
Not developmentally prepared for
Violate laws or social taboos of society
How is child exploitation defined?
Commercial or other exploitation
Use of child in work or other activities for the benefits of others
Includes: child labour, child prostitution
Which children are at risk of abuse?
Multiple moves Domestic violence Failure to thrive No emotional warmth Poor parenting: Poverty, drugs, mental health issues Disability Professionals involved
What injuries can be indicative of abuse?
Bruises/Petechiae Burns Fractures Intra-abdominal trauma Suffocation Poisoning
When would bruising not be/be concerning?
Not: Bony prominences
Yes: Head, Face, Cheek, Genitalia, Inside thigh & arm
Inc No
Different ages (old & new)
Which fractures in a child are a cause for concern?
Spiral: Twisting trauma
Bucket: Shaken baby
What are the other causes of fractures in children?
Thin bones
Prematurity
Rickets
Osteogenesis Imperfecta (Brittle bones)
When are burns in a child a cause for concern?
Delayed presentation
Lack of pain
Repeated burns (neglect)
Injury does not fit history
In burns what differential should be ruled out?
Staph Aureus Impetigo
What form of abuse causes head injuries & death in babies?
Non-accidental/abusive head injury- Shaken Baby Syndrome
How does a ‘shaken’ baby present?
Subdural bleeds Retinal bleeds Rib fractures- Posterior Long bone fractures- Baby usually thrown afterwards Brain injury Collapse May present well
What is the prognosis of shaken baby syndrome?
Very poor outlook
If baby survives usually significant brain damage
What are the signs of low level neglect?
Dental caries Severe recurrent nits Sunburn Leaving child alone Overdose Call/Methadone
What is fabricated induced illness?
Real symptoms are exaggerated Made up illness/symptoms Induced illness: Smothering causing fits Over presentation of a child Behaviour NOT a syndrome
What are the signs of sexual abuse in a Hx & Ex?
Hx: Behaviour changes, disclosure, self-harm, vaginal discharge/bleeding, wetting/soiling
Ex: Bruising on inner thighs, abnormal anogenital area, infections, discharge
What are the differentials causes of bruising that are not abuse related?
Clotting disorders Malignancy Birth marks (Mongolian birth spot) Meningococcal sepsis Drugs
What investigations should be done on <1yr olds with fractures or bruising with a suspicion of abuse
ALL!!
CT head
Skeletal survey (prev healed fractures)
Opthalmoscope (retinal haemorrhage)
When should abuse be considered?
Signif injury with no explanation
Explanation doesn’t fit injury
Explanation does not fit with motor-development stage of child
Injury in infants who are not independently mobile
Multiple injuries
Explanation changes
Multiple explanations non matching injury
Inappropriate time delay in seeking medical attention
Inappropriate parental response: Angry/unconcerned
Hx of inappropriate child response (Doesn’t cry)
Family known to SS
Prev unexplained injury
Repeated attendance
When is a social care assessment carried out after potential neglect/abuse is highlighted
Within 7 days
Verbal/written feedback & assessment given to duty manager
Undertake section 47 investigations
What happens if a section 47 investigation shows concern?
Child protection case conference convened
