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Paediatrics > Abuse & Neglect > Flashcards

Abuse & Neglect Flashcards

1
Q

What are the types of abuse?

A 
Physical
Emotional
Neglect
Sexual
Exploitation
Ficticious
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2
Q

How is physical abuse defined?

A 
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
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3
Q

How is emotional abuse defined?

A

Failure to provide a developmentally appropriate, supportive environment so child can develop stable & full range of emotions

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4
Q

How is neglect defined?

A

Failure to provide for the development of the child:

Health, education, emotional development, nutrition, shelter, safe living conditions

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5
Q

How is sexual abuse defined?

A

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

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6
Q

How is child exploitation defined?

A

Commercial or other exploitation
Use of child in work or other activities for the benefits of others
Includes: child labour, child prostitution

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7
Q

Which children are at risk of abuse?

A 
Multiple moves
Domestic violence
Failure to thrive
No emotional warmth
Poor parenting: Poverty, drugs, mental health issues
Disability
Professionals involved
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8
Q

What injuries can be indicative of abuse?

A 
Bruises/Petechiae
Burns
Fractures
Intra-abdominal trauma
Suffocation
Poisoning
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9
Q

When would bruising not be/be concerning?

A

Not: Bony prominences
Yes: Head, Face, Cheek, Genitalia, Inside thigh & arm
Inc No
Different ages (old & new)

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10
Q

Which fractures in a child are a cause for concern?

A

Spiral: Twisting trauma
Bucket: Shaken baby

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11
Q

What are the other causes of fractures in children?

A

Thin bones
Prematurity
Rickets
Osteogenesis Imperfecta (Brittle bones)

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12
Q

When are burns in a child a cause for concern?

A

Delayed presentation
Lack of pain
Repeated burns (neglect)
Injury does not fit history

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13
Q

In burns what differential should be ruled out?

A

Staph Aureus Impetigo

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14
Q

What form of abuse causes head injuries & death in babies?

A

Non-accidental/abusive head injury- Shaken Baby Syndrome

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15
Q

How does a ‘shaken’ baby present?

A 
Subdural bleeds
Retinal bleeds
Rib fractures- Posterior
Long bone fractures- Baby usually thrown afterwards
Brain injury
Collapse
May present well
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16
Q

What is the prognosis of shaken baby syndrome?

A

Very poor outlook

If baby survives usually significant brain damage

17
Q

What are the signs of low level neglect?

A 
Dental caries
Severe recurrent nits
Sunburn
Leaving child alone
Overdose Call/Methadone
18
Q

What is fabricated induced illness?

A 
Real symptoms are exaggerated 
Made up illness/symptoms
Induced illness: Smothering causing fits
Over presentation of a child
Behaviour NOT a syndrome
19
Q

What are the signs of sexual abuse in a Hx & Ex?

A

Hx: Behaviour changes, disclosure, self-harm, vaginal discharge/bleeding, wetting/soiling
Ex: Bruising on inner thighs, abnormal anogenital area, infections, discharge

20
Q

What are the differentials causes of bruising that are not abuse related?

A 
Clotting disorders
Malignancy
Birth marks (Mongolian birth spot)
Meningococcal sepsis
Drugs
21
Q

What investigations should be done on <1yr olds with fractures or bruising with a suspicion of abuse

A

ALL!!
CT head
Skeletal survey (prev healed fractures)
Opthalmoscope (retinal haemorrhage)

22
Q

When should abuse be considered?

A

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

23
Q

When is a social care assessment carried out after potential neglect/abuse is highlighted

A

Within 7 days
Verbal/written feedback & assessment given to duty manager
Undertake section 47 investigations

24
Q

What happens if a section 47 investigation shows concern?

A

Child protection case conference convened

25
Q

What is the role of the courts in child abuse?

A

Part of the Magistrate’s court
Family proceedings court: Care proceedings & emergency protection orders
Higher court: More complex cases where decisions made by judges
Criminal court: Trial for offence, seek to prove beyond all reasonable doubt
Magistrates: Cases in relation to family law, decide if an injury has occurred/who inflicted/risk assessment

26
Q

In what capacity can a doctor attend court?

A

Professional witness: Clinical findings, observations & actions
Expert witness: Help court on specialist/technical matters, consider all evidence, only give opinions within professional competence

27
Q

What are the red flags for physical abuse?

A

Parent: Lack of concern, preoccupied, paranoid, fail to wait
Child: Sad, withdrawn, disclosure by child

28
Q

What are the red flags for potential sexual abuse?

A 
Disclosure
Local trauma
Early sexual conduct
Pregnancy
Emotional effects
Self-harm
Poor concentration
Soiling &amp; wetting
Low mood
Drugs &amp; alcohol
Eating disorders
29
Q

What are the types of emotional abuse?

A

Rejecting: Not acknowledging worth, legitimacy of needs
Isolating: Prevents friendship
Terrorising: Verbally abusive, hostile
Ignoring: Deprives stimulation
Corrupting: Encourages anti-social behaviour

30
Q

What is the most likely diagnosis:
2yo boy attends A&E after falling out of a 1st floor window. He was unattended at the time. OE he has a R-sided extradural haematoma & left hemiplegia

A

Neglect

31
Q

What is the most likely diagnosis:

3mo girl w/humeral #. Dad says she rolled off the bed onto a hard wooden floor

A

Non-accidental injury (physical abuse)

32
Q

What is the most likely diagnosis:
3w Asian child reported by the health visitor who noticed bruising on his buttocks & Sacrum. Suspected smacking the baby for crying

A

Normal variant (Mongolian Blue Spot)

Paediatrics (26 decks)

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