Child Abuse Flashcards
What are the four forms of child abuse?
Physical
Sexual
Emotional
Medical
What are the four forms of child neglect?
Physical
Emotional - “Non-organic failure to thrive”
Medical Care
Educational
How may adverse childhood experiences lead to lifelong problems and possibly early death?
Adverse childhood experiences ->
Social, emotional, cognitive impairment ->
Adoption of health risk behaviors ->
Disease, disability, and social problems ->
Early death
What are the legal requirements for reporting child abuse to authorities?
All 50 states in the United States require any professional who works with children to report suspected cases to the designated authority. There are civil and criminal legal consequences for failure to report.
Reports can be made to Child Welfare child abuse hotlines or to law enforcement. Child Welfare agencies will generally only investigate intra-familial abuse and neglect. Law enforcement will generally investigate intra and extra familial abuse and neglect.
In Colorado, the Kempe Child Protection Team has a physician and a social worker on call 24/7 through Children’s Hospital: 720-777-1234. Any suspected case seen in our affiliated hospitals or clinical rotations can be discussed with this team. We are available for consultation any time wherever you are or wherever you go in the future.
Common historical features in child abuse cases
Discrepant History - does not fit with exam findings
Delay in seeking care
Stressed caretaker
Behavior by the child that triggers the abuse
- Crying in infants and toileting accidents most common
Prior history of abuse in the abuser
Unrealistic expectations of the child
Social Isolation of caretaker
Pattern of increased severity of injury if first injuries unrecognized.
Use of multiple hospitals or caretakers
It is important to realize that the person who brings the child for care may have no idea what happened to the child and therefore it is imperative not to accuse any caretaker of abuse.
Why is the developmental age of a child a critical factor in assessing safety?
The same type or severity of abuse that may cause harm to an older child could every injure or kill a small child. A handprint bruise on a three week old is a child protection emergency. The same hand print on a 15 year old, while not appropriate, is less emergent.
What are some signs that may indicate abuse?
Bite marks with adult teeth Burn patterns Multiple or linear skull fractures Spiral fractures of long bones Metaphyseal plate fractures Subdural hemorrhage Retinal hemorrhages
What conditions are commonly associated with child abuse?
Alcohol abuse Drug abuse - Methamphetamine particularly dangerous Interpersonal violence - Spouse/partner abuse
What is one intervention that has been shown to sharply reduce physical abuse?
Public Health Nurse home visitation
Randomized controlled trials have shown that PHN visitation during last two trimesters of pregnancy and the first two years of the child’s life can reduce physical abuse by 87% over the lifespan of the child (Olds).
What are the four preconditions for sexual abuse?
Precondition #1 is an individual who is aroused and/or views sexual involvement with children as “normal”, and may be blocked from a developmentally appropriate sexual relationship.
Precondition #2 – internal inhibitors – are our laws and moral standards that prohibit sexual relationships with children. Drugs and alcohol are potent dis-inhibitors.
Precondition #3 - external inhibitors - relies on the presence of other individuals whose presence will protect children from abuse.
Precondition #4 is resilience by the child, which is often related to a child’s self esteem (the lower the child’s self esteem, the more likely the child to be preyed upon). Resilience can be eroded over time, and most sexual abuse is a seduction and engagement in sexual activity over time.
What gene has been shown to be involved in nurturing of offspring in mice?
FosB
A fobs knockout mother never made a nest, never licked or nursed her babies and did not retrieve them when they wandered away. They all died.
A male or female with the gene placed in the knockout cage after delivery will make a nest, retrieve the babies and keep them warm.
Activity level of what gene has been shown to correlate with healthy survival of abuse?
MAO activity
Caspi found that the higher the MAOA level in the maltreated boys, the less likely they were to become antisocial.
In other words, the presence of the gene for MAOA is associated with “survival” of early abuse. Low levels led to repetition of the cycle.
What brain changes have been noted in child abusers?
Pedophiles have reduced volume of the amygdala (area of brain critical for sexual development) compared to non-pedophiles
