child abuse Flashcards
physical abuse
deliberate physical force- that leads to a physical unjurt t that child
what are all the forms of abuse
sexual, pyhysical, psychological and neglect
psycological scars
although we cannot see psycological scars, they are still there and are important in regars to abuse
imbalance of power
child will not rat ou partent because they feel they are nothing without them
what three things to do if abuse is suspected?
1) through history 2) physcial examination 3) radiologic examination
what are the general injury characteristics?
1) injuries in various stages of healing
2) multiplanar injuries (dont make anatomical sense)
3) patterned injuries (hands, belt buckles)
4) locations typical of assault
What are the %’s for abuse fractures in childhood vs >1 year olds?
30% childhood and 75% for >1 year olds
rib fractures
usually anterior and posterior. If significant, may damage the underlying organs
humeral and femural
most likly an inflicted injury
What two things are important when looking into injuries in children, more important than fracture direction?
age and location
age 0-1 ___ and age 1-2 ____. The injuries commonly seen in these age groups?
age 0-1 is 1/3, 85-90% head injuries
age 1-2 is 2/3, 50% head, 50% blunt abdominal injuries
what increases the rate of detection of child abuse?
systemic screening- increases 5X
What are the 5 child abuse mimics?
1) congenital indifference to pain
2) congenital insensitivity to pain
3) congenital conditions such as meningomyelocele
4) acquired spinal cord injuries
5) acquired cerebral inuries
skeletal survey?
it is a precise set of defined X-ray views to get a full picture of potential abuse cases
What is subdural haemorrhaging? what causes it?
bleeding of the brain between the internal aspect of the skull between brain. It is often caused by the severing of the bridging viens in the skull
Inconsistency of story and injury?
1) incompatible injuries with age of the child
2) injuries disproportionate to their purposed cause
3) injuries may be inappropriate to the purported mechanism of injury
“wrong age, wrong magnitude, wrong mechanism”
mutiple fractures at mutliple sites and multiple stages of healing?
indicative of repeated injury. Most commonly seen in long bones, skull and ribs
What are the two usual types of single fractures seen in children?
transverse fractures and spiral fractures. “a child with a single acute fracture is quite hard to diagnose”
Most common fracture sites (in decreasing order)
Long bone, skull, ribs
What is just as important as X rays in diagnosing abuse?
X rays are suggestive and diagnosis
exams and history is also important
What can happen during delivery?
accidental distal humerus #
deliberat clavicular #
Salter-Harris epiphyseal type 1 injuries?
a seperation at the ephyseal and metapseal plates during child birth
What are some diseases that may simulate abuse in X-rays?
1) congenital syphillis
2) scurvy
3) hypervitaminosis A
4) caffey’s disease
5) osteogenesis imperfecta