Child Abuse

Question 1

How might you define child abuse?

Answer 1

• anynon-accidental behaviourby others that is outside the norms of conduct
• entails a substantial risk of causingphysical or emotional harmto a child or young person
• May beintentionalorunintentional
• Can includeomissionandcommission

Question 2

What are the main types of child abuse? Briefly explain them.

Answer 2

1. Physical abuse: inc. Munchausen’s by proxy, some non-injurious forces
2. Emotional maltreatment: failure to provide with adequate emotional nurture and availability e.g. rejecting, isolating, corrupting
3. Neglect: failure to provide with conditions hat are culturally accepted as being essential for their physical and emotional development and wellbeing
   
   • Physical, emotional educational, environmental
4. Sexual abuse

Question 3

Who must you contact in an abuse case? What do they do?

Answer 3

Victorian Forensic Paediatric Medical Service:

• <72h for sexual abuse
• A forensic medical service for under 18 year olds
• Assessments and care for abused, assaulted & neglected children & young people

Question 4

What are some indicators of abuse of history?

Answer 4

• Repeated complaints of illness, for which no medical explanation can be found
• The ‘accident prone’ toddler or child
• Inconsistent or implausible history of injury
• Sudden Unexpected Death of Infant (SUDI) or ‘near miss’, especially if there is a history of similar episodes involving either the presenting child or other siblings
• Persistent parental concern about a baby’s medical condition may be indicative of post-partum depression, therefore an assessment of the mother’s emotional state must also be made
• Delay in seeking medical attention, or ‘failure to thrive’ may indicate that a baby is being neglected

Question 5

What are some indicators of abuse on examination?

Answer 5

• bruising or bite marks
  
  • Buttock/ear/back/belly/pattern bruising e.g. tramline bruising
• scars e.g. cigarette burns
• napkin dermatitis
• anal or vaginal excoriation or injury
• finger marks on arms or trunk: ?shaking injury
• retinal haemorrhages
• pain or reluctance to move a limb: ?fracture
• apathy, lethargy
• developmental delay
• plot growth - FFT

Question 6

What is the triad of findings in ‘shaken baby syndrome’?

Answer 6

1. Retinal haemorrhaging
2. Subdural haematoma
3. Brain swelling

Question 7

Who should you refer to if you think the child is at risk of being harmed, but not yet being harmed?

Answer 7

Child Wellbeing Referral:

• if you think the child is at risk of harm, but not yet in harm
• Services that help the family support child i.e. support services, before child protection