Child Abuse

Question 1

What is the role of health care workers in cases of child abuse

Answer 1

Recognize child abuse; accurately document the extent of the clinical findings (physical or
psychological)
* Provide appropriate treatment of the injuries sustained; and
* Report the case to the appropriate authorities.

Question 2

What circumstances should raise suspicion of child abuse

Answer 2

. Unexplained injuries
* Discrepant histories
* Delay in seeking medical care
* Alleged self-inflicted injuries
* Alleged third-party inflicted injury
* Repeated injuries
* Sexualized behaviour
* Sexually transmitted disease (STD)

Question 3

Outline the types of child abuse

Answer 3

1. Physical Abuse
2. Child Sexual abuse :
   -intercourse (rape)
   -touching, fondling or any contact with child genitals or breasts
   -masurbation of child by adult or vise versa and masturbating in presence of a child
   -body contact with adult genitals
   -exhibitionism
   -pornography and erotic talk

(often leaves no signs on victim)
3. Nutrition deprivation
4. Intentional drugging
5. Medical acre neglect, child with chronic conditions not given meds.
6. safety neglect
7. Emotional abuse- rejecting child and blaming them for wrong things, verbally abusing them
9. Organized abuse - organized crime, pedophilic and pornographic rings, cults
8. Bullying and cyberbullying (Bullying is aggressive behaviour by one person or group carried out repeatedly overtime and involves power differential. cyberbullying is use of the internet to inflict harm on another)

Question 4

What are come of the typical presentations of physical abuse

Answer 4

1. Head injuries: fractures, Intracranial injuries
2. Truncan injuries
3. Extremeties
4. Superficial injuries:
   -cuts and bruises
   -burns
   -signs of hypothermia and frost bite
5. suffocation
6. Poisoning

Question 5

What type of skeletal fractures in <3 prompt a suspicion for child abuse

Answer 5

chip fracture (corner or bucket handle fracture) of the long bones

Question 6

Which conditions may be mistaken for abuse in children

Answer 6

• Birth trauma: should be evident from the birth history.
• Congenital syphilis: chronic periosteal reaction combined with metaphyseal widening and positive blood tests.
• Osteogenesis imperfecta: multiple fractures, blue sclerae, osteopaenia.
• Rickets: renal disease, bowed long bones, blood abnormalities.
• Scurvy: poor wound healing, bleeding gums, petechiae.
• Bleeding disorders: haemophilia, meningococcaemia.
• Skin diseases: impetigo, chicken pox, scaled skin syndrome—may mimic burns.

Question 7

What are the signs of sexual abuse in children

Answer 7

• Recurrent abdominal pain
• Difficulty walking or sitting
• Painful micturition and recurrent urinary tract infections
• Faecal soiling or retention
• Discharge from penis or vagina
• Abnormal dilatation of vagina/anus
• Genital laceration/bruising
• Vaginal bleeding
• Signs of sexually transmitted infections