Child Abuse

Question 1

When should you suspect abuse?

Answer 1

story doesn’t fit
long sleeve shirt on hot day
role reversal–kid taking care of parent
hx of child abuse in parents

Question 2

What are the most common findings of child abuse?

Answer 2

cutaneous bruising

**but see if they have low platelets

Question 3

How hard is too hard to spank your child?

Answer 3

if you’re leaving bruises–too hard, abusive.

Question 4

Where are normal bruises located?

Answer 4

on bony prominences that can be hit during a fall
forearms, wrists, knees, shins
NOT back, face etc.
NOT normal if you are super young & can’t even walk around enough to fall

Question 5

Other things to consider with bruising?

Answer 5

birthmarks
mongolian spots
phytophotodermatitis
coagulopathy
ehlers-danlos syndrome
cupping practice
bullous impitigo
**can always re-check the kid in 72 hours for progression of the bruise

Question 6

How can you tell if a burn is intentional?

Answer 6

Intentional: symmetrical, circumscribed, same depth
Unintentional: splash pattern, more random

Question 7

What is an appropriate hot water heater temperature?

Answer 7

120 degrees

if 140, takes 1 second to sustain a second degree burn

Question 8

T/F A laxative or garlic can cause superficial burns.

Answer 8

True.

Question 9

What is an important part of a child abuse work-up?

Answer 9

skeletal survey–gets tons of pictures & detects fractures

CT scan

Question 10

What is the ddx for fractures?

Answer 10

accidental
OB
prematurity leading to osteopenia
nutritional deficiency
etc

Question 11

T/F Abdominal trauma is less damaging to children, rarely fatal.

Answer 11

False. Very dangerous b/c not very much musculature in abdominal wall & internal organs can get damaged. #2 cause of death.

Question 12

Some things seen w/ abuse head trauma

Answer 12

intracranial bleeding
edema
retinal hemorrhage
sometimes see subdural hematomas (tearing of bridging veins), whiplash injuries

Question 13

What is an exception to the rule that a low level fall won’t kills you?

Answer 13

Very short fall that hits just right can cause epidural hematoma & kill you.
also if you have an intracranial defect, bleeding disorder, ruptured AV malformation, glutaric acidemia type 1.

Question 14

T/F You can rarely get retinal hemorrhage w/o abusive head trauma, such as being kicked by a horse.

Answer 14

True.

Can also get them sometimes during birth, but disappear w/i a week.