Child Abuse Flashcards
Epidemiology of child abuse?
- Highest risk in first year of life
- Highest fatality rates in children < 3 years of age
- Biological parent is perpetrator in 80% of cases
- Neglect is most common type of maltreatment (75%), followed by physical abuse (17%)
- There is a high recurrence risk for maltreatment
Types of maltreatment?
- Abuse
- Emotional
- Sexual
- Physical: non-accidental trauma - Neglect
Parental/household risk factors for child abuse?
- Substance abuse
- Mental illness
- Interpersonal violence (IPV)
- Single and/or teen parent
- Non-related adult in the home
- Unrealistic expectations of child or negative perception of normal childhood behaviors
- Prior abuse in household
Social risk factors for child abuse?
- Social isolation
- Poverty
- Lower levels of education
- Large family size
- Family stressors
Child related risk factors for child abuse?
- Prematurity
- Low birth weight
- Developmental and/or physical disabilities
- ADHD
- Unplanned or undesired pregnancy
- Chronic or recurrent illnesses
- Developmental stage of child can be a risk, e.g. colic
Obtaining history in child abuse?
- Separate interviews with each caregiver and verbal person in household
- Allow to provide history without interruption
- Need to know mechanism of injury, events leading up to injury, and if event witnessed
- Onset and progression of symptoms
General PMH, social & family history - Think about family hx of coagulopathies, bone disorders
History red flags?
- No reported hx of trauma
- A history of trauma inconsistent with the severity, pattern, or timing of the injury
- Injury inconsistent with developmental stage of child
- Multiple or evolving injuries
- Discrepant histories from the same caregiver or between caregivers
- Injury attributed to a sibling or pet
- Delay in seeking care
- Delays that complicate care, prolong pain, or that occur in children with obvious, severe distress (e.g., actively seizing, coma, or respiratory distress) are suspicious for abuse
History of child abuse in the late toddler and early preschool ages?
- in the late toddler and early preschool ages, children may be active and independent enough to injure themselves unintentionally, but lack sufficient communication skills to explain what happened
- Minor injuries in these children are expected, and not always explained
- Serious and internal injuries, however, still raise concern for abuse when an appropriate mechanism of injury isnotprovided by the caregiver.
Physical exam in child abuse?
- Make sure child undressed and all skin examined
- Pay attention to areas that may be overlooked: pinnae, frenulae, teeth, palms and soles, GU/anus
- Assess nutritional status
- Take note of paradoxical comfort
- Document with drawings or photograph all injuries
What is paradoxical comfort?
a baby who is more comfortable when not being held but cries when picked up
- may be observed in infants with occult injuries such as rib fractures
In the physical exam of child abuse what body parts do you pay close attention to?
- Scalp and fontanels
- Ears
- Oral cavity, including the buccal mucosa, labial and lingual frenula; the teeth; and the posterior pharyngeal wall
- Folds of the neck
- Buttocks
- Genitals
- Palms and soles
Exam red flags?
- Skin is the most frequently injured organ, with bruises, bites, and burns
- “TEN 4” - Torso, Ear, Neck, and 4
- children < 4 yrs & bruising in infants < 4 months - Bruising on buttocks
- bruising and abrasions
- human bite marks
- abusive burns
- Retinal hemorrhages
- Unequal breath sounds
- Muffled heart sounds
- Abnormal abdominal exam
Describe the bruising and abrasions in child abuse?
- In > one body surface
- Multiple stages of healing
- Patterned or well demarcated
Describe human bite marks in child abuse?
- Crush injuries, ovoid pattern of tooth marks
- Central area of bruising, > 2 cm between the maxillary canine (adult)
Describe abusive burns in child abuse?
- Severe (usually full thickness)
- Require more extensive treatment
- Usually, well-demarcated and confluent