Child Abuse ๐ฅบ Flashcards
What is the most common cause of lethal child abuse?
Abusive head trauma **!!! Must know*
What ethnic groups have disproportionately higher child deaths in Arizona?
African American
American Indian
What are the leading causes of death in childern ages 1-4
- Accidents
- Congenital malformation, chromosomal abnormalities
- Assault (Homicide)***
Who are the main perpetrators of child abuse?
Parents 81%
Step-parent/momโs new boyfriend: 12%
Other adult 7%
What are the parental risk factors that make them more likely to become abusers?
Young age/single parent
Low education
Poverty
Drug/alcohol abuse
Domestic violence in household
Unrealistic expectations of baby/kid
Unrelated adult male in household (momโs new boyfriend)
Social isolation
Hx of animal cruelty
What are the risk factors for babies and children that makes them more likely to get abused?
Medical conditions- learning disability, prematurity (fussier), ADHD (talkative/energetic), etc
Non-biologic caregiver- adopted child, step-parent
Age- most common in children <3 years!!**
Prior abuse
Unplanned pregnancy, unwanted child
Who usually reports child abuse?
Teachers
Law enforcement
Social services
Medical personnel
What are the 4 types of abuse?
Neglect (75%)
Physical (44%)
Sexual (8.5%)
Emotional (7%)
Where are the normal places for a little kid to have bruises?
Bony prominences:
Forehead
Knees
Front of body
What are some characteristics of bruising that are suspicious for child abuse?
Central bruising- buttocks, back, trunk, genitals, inner thighs, neck, EARS**๐๐ป๐๐ป
Bruising in babies that arenโt mobile on their own or <6 months
Clustered bruises
Human bite marks
Are ear bruises ever normal?
NO
She said this soooo many times
What kind of shapes would bruises appear if they were caused by abuse?
Handprints/oval finger marks
Loop marks- rope, wire, cords
Linear- whipping, paddling
Belt marks- may end in horse shoe shape
Ligature marks- neck, wrists, ankles, corners of mouth if baby was gagged
Bruising over the pinna of the ear- blow to ear or side of head
You notice bite marks on your pediatric patient. Their dad claims it was from his 4 year old brother. How would you tell if this was true?
Measure the distance between the maxillary inter-canines. (2.5-3cm in an adult)
Should you swab a bite mark for DNA
Yes
What kind of abuse are bite marks associated with
Sexual abuse
What kind of pattern would make you think that a baby burned itself on accident?
Irregular, top-down pattern like if a baby pulled a hot pot of soup down on themselves
What are some suspicious burns?
Brands- imprint from an object
Immersion- stocking glove, buttocks, leg
Cigarette burns
Cigarette burns tend to be _____ degree and heal (fast/slow) with ______
Third degree**
Slowly with scarring**
Where are cigarette burns usually located on a baby
Back of hands/feet
Face
What should a frenulum tear make you think?
Force feeding
Is it common to see orofacial injuries in abused children?
Yes, occurs in up to 50% of abused kids
What are some examples of orofacial injuries that were caused by abuse?
Frenulum tears
Lip lacerations
Missing/broken teeth
Tongue injuries
Burns from scalding foods
Facial fractures, basilar skull fractures, perioribtal ecchymosis
Ear bruising
Traumatic alopecia (missing clumps of hair)
Bruising/lichenificatino at corners of mouth
What can cause bruising/lichenification at corners of mouth
Being gagged
What is the second most common injury in physical abuse after bruises?
Fractures
What are fractures of high suspicion?
Rib fractures in babies
Long bone fractures in non-walking children
Sternum/scapula or spinal fractures (HIGH impact required)
Multiple fractures in various stages of healing
Depressed skull fractures
What causes depressed skull fractures?
Being struck by something (not from falling down)
๐จ๐๏ธโโ๏ธโฑ๏ธ
What are the 2 most comon types of fractures in abuse?
Metaphysical lesions of long bones (pulling baby out of crib with leg stuck in grates)
Rib fractures due to forceful compression while shaking (usually posterior ribs near the spine)
What are some behavioral changes that a child who is being sexually abused may exhibit?
Regress with toileting (suddenly starts pooping pants)
Personality changes- depressed, angry, reserved
Are boys or girls more likely to be sexually abused?
Girls, but boys are less likely to report so this is prob skewed
Is it OK to ask a kid if theyโre being sexually abused if their mom is sitting right there?
Yes, you want the child to be as comfortable as possible
What do you need to look for during your exam if you suspect sexual abuse?
Vaginal, penile, anal trauma
Oral exam for forced oral sex
STI screening
Pregnancy testing in adolescents
What do you NEED to do if you suspect sexual abuse?
Collect forensic evidence, especially if the abuse occurred in the last 24 hrs
All neglect encompasses _____ and _____ harm
Actual
Potential
(Potential harm, like if the deprivation of medical care went on for awhile, that would be actual harm)
What is neglect?
Failure to provide a child basic needs