Child Abuse Flashcards
What are the three levels of stress response
- positive - brief increases in heart rate, mild elevations in stress hormone levels
- tolerable - serious, temporary stress responses, buffered by supportive relationships
- Toxic 0 prolonged activation of stress response systems in the absence of protective relationships
What are the 3 goals for medical evaluation of a suspected child abuse case
- determine the full extent of the child’s injuries
- determine if injuries are consistent with history provided
- prevent misdiagnosis of abuse
What are some labs ordered for occult trauma/ingestion
- CBC
PT/PTT
LFT
Amylase/lipase
Urinalysis
CPK
Urine toxicology
What are labs ordered for differential diagnosis of fractures
Calcium
Phosphorus
Alk Phos
ViT D 2% OH
PTH
Labs ordered for signs of neglect/malnutrition
Total protein
Albumin
Pre albumin
Mineral and vit deficiencies
What are the fractures concerning for abuse?
Metaphysical fractures
Rib fractures
Sternal fractures
Acromion fractures
Scapular fractures
Spinous process fractures
Anterior compression of vertebral body
What fractures are concerning but can be accidental
Mid-shaft clavicular
Long bone shaft
Linear skull fractures
What is the acute healing period of fractures
Up to 7 days
What is the time frame for soft callus formation
7-10 days
What is the time frame for hard callus formation
10-14 days
What is the time frame for remodeling
Up to several months
Which bony fractures are the hardest to date
Skull bones
Metaphysical
What bones are usually involved in birth trauma
Humeral and clavicular fractures
What is the most common indication of physical abuse
Bruises
What does a yellow bruise usually indicate
Bruise is more than 18 hours
What does a purple bruise usually represent
Present from 1 hour to resolution
What does a red bruise indicate
Red color can be present anytime
What are the two characteristics used to separate abusive bruised from accidental bruises
Location
Pattern
What are high risk areas for abusive bruises?
TEN-4 FACES
Torso - chest, abdomen, back, buttocks
Ears
Neck
Frenulum
Angle of jaw
Cheek
Eyelid
Sclera
What are some accidental bruise locations
Shin
Lower arms
Under chin
Forehead
Hips
Elbows
Ankles
Bony prominences
What are some abusive bruise locations
Anterior thigh
Upper arms
Neck
Face
Buttocks
Trunk
Ears
Genitalia
What are some inflicted abuse patterns
- patterned
- well demarcated edges
- often uniform depth of burn
- unusual location
What does subconjuctival hemorrhages indicate?
Sentinel injury - my be an indicator of physical abuse
What is the 2nd leading cause of abuse fatalities
Abdominal trauma
What is the most common form of maltreatment
Neglect
