Abuse/Neglect/Shaken Baby Flashcards
What is the legal term for a report of child abuse or neglect? WHO, by law, is considered to be a MANDATED reporter?
-WHEN must a report be made?
51A report
- anyone with a PROFESSIONAL responsibility for children (includes any/all docs)
- where there is SUSPICION/reason to believe that a child has been abused/neglected
potential consequence if you…
- don’t report suspected abuse/neglect, child is INJURED:
- don’t report suspected abuse/neglect, child DIES:
injured: license loss/fine
dies: license loss/fine, JAIL
approximately how many kids DIE each year from suspected child abuse/neglect?
~1,500, give or take 100ish
Most common fatalities:
- boys/girls?
- AA/white/hispanic?
- more than 75% of deaths are under WHAT age?
white boys, usually LESS THAN 3 Y/O
~80% of fatalities involved at least one ____
-another 15% of fatalities are performed by a perpetrator (with/without) a PARENTAL RELATIONSHIP to the child
PARENT
- 15% WITHOUT parental relationship (but still known)
- only 5% by UNKNOWN perpetrator
About what percent of reported cases of abuse/neglect actually get “screened in”
~60%
MOST COMMON type of maltreatment?
NEGLECT (75%)
17% physical abuse, 8% sexual abuse, 7% “other”
for YOUNGER victims: boys/girls more commonly victimized?
for OLDER: boys/girls?
-who dies more? boys/girls?
younger: boys
older: girls (sexual)
boys die more
Bruises (physical abuse) are concerning when they’re in multiple locations, unusual locations, and/or when they have WHAT characteristics?
- different healing stages
- oddly shaped
- small, round, oval
- @ corners of mouth, wrists/ankles
- loop or linear shapes
-DON’T mistake for congenital mongolian spots, hemangiomas, accidentals, CT disorders, coining, or cupping (cultural)
Sexual abuse:
1 in __-__ girls by 18Y/O
1 in __-__ boys by 18 Y/O
__% KNOW offender
__% are committed BY __, AGAINST ___
3-4
6-10
85%
96% men against women/children
If you suspect ANY type of abuse, you have ___hrs to VERBALLY report, and ___hrs to submit a ____ report
-DCF (Massachusetts type of CPS) has __ days to investigate a 51A report that was screened in
24h verbal
48h written
10 days
T/F: YOUR role is not to determine guilt, innocence, or outcome, but rather, to gather basic info and interview parent/child separately
true
-may sure to ask both parent/child (separately) - how it happened, where/what/when/who
In most cases, you should tell the parent that you will be filing a 51a…EXCEPT in which circumstances?
DON’T tell parent you’re filing if:
- domestic violence
- kidnapping threat
- guns/drugs in home
- suicidal parent
- parents w/ hx of threatening to harm child if tell, or if they abuse the child after report was made
T/F: about 40% of cases are d/t false allegations by children trying to get their parents in trouble, or by docs that don’t like the parents
false. only ~1%.
Most common intracranial hemorrhage in SBS?
Most common eye finding in SBS
Other classic signs of shaken baby syndrome?
SUBDURAL
RETINAL hemorrhaging (multi-layer)
-skeletal injuries, esp fractured RIBS, LONG bones in parents w/ an inconsistent hx and/or delay in seeking medical care
One of the biggest triggers to SBS?
Prolonged crying
Mech: weak neck muscles can’t support head weight, angular acceleration/deceleration lead to shearing/traction on vitreoretinal adhesion sites
-NO surface impact necessary
Symptoms of child w/ SBS are usually (delayed/immediate), and include what?
**most common misdiagnosis of SBS
IMMEDIATE - irritability, lethargy (or poor feeding), vomiting, bruising, seizures
-Viral gastroenteritis!! (general flu-like sx)
T/F: mild/moderate abuse will likely lead to SBS sx/signs/retinal hemes?
FALSE. must be severe/serious car accident or significant fall onto hard surface/concrete
Retinal hemorrhage ddx:
- accidental trauma (severe only)
- birth trauma: most hemes present d/t birth are gone by __ wks
- CPR - key differential?
birth trauma: hemes gone by 6 wks
-CPR: hemes will only be 1 or 2
Up to ___% of victims die from SBS injuries
-two common manifestations of abnormal visual fxn?
25% (1 in 4 die)
- CVI, optic atrophy
- note: amblyopia also possible if (+)vit heme lead to dense amblyo over long course
How many cases of SBS are reported annually in the U.S.?
Typically, victims are how old?
1,000/year
Other ddx for retinal hemorrhages:
accidental trauma, birth trauma (resolved in 6wks), CPR/Purtcher, terson, ruptured cerebral aneurysm, CNS infx, seizures, blood anomaly (anemia/leukemia)
5 types of disclosure for a child to tell you they’ve been abused/neglected? (DTARR)
DTARR
Denial, tentative disclosure, active disclosure, recanting, reaffirmation
-AVOID these!
