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X Pediatrics 2 > Child Abuse > Flashcards

Child Abuse Flashcards

1
Q

When do more than half of deaths from child abuse occur?

A

<12 mos (child abuse in general occurs most <3)

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2
Q

Most common cause of lethal child abuse

A

Abusive head trauma

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3
Q

Most common injury to infants <6 mos

A

Battery

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4
Q

Ethnicity seen highest in child deaths

A

African American and American Indian

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5
Q

Leading causes of death ages 1-4 YO

A

Accidents (unintentional injuries)
Congenital malformations/deformities/chromosomal abnorm
Assault (homicide)

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6
Q

Leading causes of death ages 5-14 YO

A

Accidents (unintentional injuries)
Cancer
Intentional self-harm (suicide)

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7
Q

Most common perpetrators of child abuse

A

Parents (81%)
Step parent or partner
Other adult

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8
Q

Parental risk factors of child abuse

A

Most common are young age or single parents and lower level of education
Others: poverty, hx of drug or EtOH abuse, domestic violence in house, unrealistic expectations of child, parental hx of abuse, unrelated male in house, social isoluaiton, history of animal cruelty

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9
Q

Risk factors for babies in child abuse

A 
Medical conditions (learning, preemie, ADHD, congenital abnormalities, FTT)
Non-biologic caregiver
Age (<3)
Prior abuse
Unplanned or unwanted child
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10
Q

Categories of child abuse

A

Neglect (most)
Physical
Sexual
Emotional

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11
Q

Examples of physical abuse

A

Bruising (most common), burns, orofacial injuries, fractures (second common)

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12
Q

Characteristics of unintentional bruising

A

Bony prominences like forehead, knees or front of body from running into things

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13
Q

Characteristics of inflicted bruising

A

Central bruising (butt, back, trunk, genitals especially EARS)
Bruising in babies who aren’t mobile or <6 mos
Multiple bruises in clusters
Human bite marks

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14
Q

Common types of bruises seen

A 
Handprints or oval finger marks
Loop marks (rope, wire, electrical cord)
Linear bruises (whips, paddles)
Belt marks (broad band with horse-shoe shape)
Ligature marks (neck, wrist, corner of mouth)
Bruising on pinna of ear from blow to ear or head
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15
Q

What does facial petechiae usually indicate?

A

Hard blow to head or face

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16
Q

What do you want to look for with ligature marks on neck?

A

Scratching at face or airway from trying to breathe

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17
Q

What can bruise bites be associated with?

A

Sexual abuse

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18
Q

Characteristics of bruising bites

A

Circular area of ecchymosis and superficial abrasions (may see central clearing or petechiae)

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19
Q

How can you distinguish adult and child bite marks?

A

Distance b/w maxillary inter-canines (2.5-3 cm in adult)

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20
Q

When do you suspect child abuse with burns?

A

Scalds in kids <5 without unintentional spill pattern

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21
Q

Types of burns

A

Brands (object imprint)
Immersion (stocking glove, butt or leg)
Cigarettes (third degree, heal slowly with scarring usually on dorsum of hands and feet or face)

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22
Q

What types of orofacial injuries can indicate physical abuse?

A

Frenulum tears, lip lacerations, missing or fractured teeth, tongue injuries, burns from scalding food
Facial or skull fractures, periorbital ecchymosis
Ear bruising
Traumatic alopecia
Bruising or lichenificaiton or scars at corner of mouth

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23
Q

Fractures of high suspicion for child abuse

A

Rib fractures in babies, especially <1 YO
Long bone fractures in non-walking kids (or <5)
Sternum/scapula/spine fractures
Multiple with various stages of healing
Depressed skull fractures

24
Q

2 most common types of fractures

A

Metaphyseal leisons of long bones (infancy)

Rib fractures due to forceful compression of ribs while shaking (posterior ribs near costovertebral articulation)

25
Q

Some sxs of sexual abuse

A

Reserved, depressed, angry, regressing with toileting

26
Q

Types of neglect

A

Physical (food, shelter, hygiene)
Psychological (emotional)
Education
Medical (have opportunity but don’t take)

27
Q

Types of emotional neglect

A

Rejection, isolation, terrorizing, ignoring, corrupting, verbal assault, over-pressuring

28
Q

Types of induced illness

A

Forced ingestion leading to salt poisoning, water intoxication or prescription and illicit drugs

29
Q

Characteristics of unintentional head injury

A

Localized swelling following injury
Lethargy
Concern for children who were asymptomatic

30
Q

Sxs that bring a child in from an abusive head injury

A

Breathing difficulties
Apnea
Seizures
Lifelessness

31
Q

When do you see epidural hemorrhage more?

A

Occurs more frequently in unintentional head trauma

32
Q

Characteristics of subdural hemorrhage

A

Not usually accidental (would require significant force-MVA or drop from large height)
Most will have past hx of SDH

33
Q

What is present in most fatal inflicted head traumas?

A

Subarachnoid hemorrhage (can be unintentional trauma tho)

34
Q

Retinal hemorrhages in child abuse?

A

Frequent in abusive head trauma (numerous)

Less severe retinal hemorrhage (maybe 1 or 2) can be seen in unintentional

35
Q

What kind of skull fracture might indicate abuse?

A

Complex, depressed skull fracture

36
Q

Differentials for bruising

A

Salicylate ingestion
Mongolian spots
Coagulopathy
Vasculitis

37
Q

Characteristics of salicyclate (ASA) ingestion

A

Diffuse bruising
Tachypena, hyperthermia, tachycardia, hypotension
Vomiting
*check plasma salicylate conc

38
Q

Characteristics of Mongolian spots

A

African American, Asian or Hispanic
Lower back or butt but can be upper back or extrems
No swelling or tenderness
Fade over months to yrs

39
Q

Characteristics of vasculitis

A

Purpuric rash/lesions b/c of breakdown of vascular walls

HSP (LE, arthralgia, abd pain)

40
Q

Coagulopathy and child abuse

A

Review medical and family hx
If abuse is witnessed then don’t need coag studies
If not witnessed than maybe coag studies and CBC with diff (always with head trauma)

41
Q

Differentials for fractures

A 
Osteogenesis imperfecta (brittle bones)
Nutritional deficiencies (vit D)
Pathologic (neoplasms)
42
Q

Differentials for burns

A

Unintentional
Impetigo
Phytophotodermatitis

43
Q

What is impetigo?

A

Infection of skin by staph or strep but can look like cig burns
Superficial layers only where cigs will be third degree and have scarring

44
Q

What is phytophotodermatitis?

A

Burn-like skin lesion when sun interacts with certain fruits or veggies (lemons, oranges, celery, figs)

45
Q

Other important differentials for child abuse

A

Congenital pain insensitivity

Cultural practices

46
Q

What is congenital pain insensitvity?

A

Sensory and autonomic neuropathies so decreased sensation to pain and sometimes temp
Do a thorough neuro exam

47
Q

Some cultural practices to consider that aren’t child abuse

A

Cupping
Coining (petechiae and ecchymosis-SE Asia)
Spooning (China)

48
Q

Injuries with high suspicion of abuse

A

Bruises on trunk, ear and eck
Bruises in infants who aren’t cruising
Long bone fractures in non-walking babies
Rib fractures <1
Subdural hematomas <1
Hollow viscous injury <4 (ruptured bowel)

49
Q

History components to raise suspicion

A 
History inconsistent with injury
MOI changes
History is vague
Injury blamed on baby or siblings
Implausible
History of prior bruising in non-cruising
Injury due to in home resuscitation
50
Q

Suspicious parent behavior

A 
Delay in seeking care
Lack of concern for severity
Aloofness
Argumentative or violent
Partial confession
51
Q

Labs for suspected child abuse

A 
Coag
CBC with diff
CMP with ALT and AST (liveR)
Amylase and lipase (pancreas)
UA
Toxicology
Stool guaiac
52
Q

Imaging for skull fractures

A

Non contrast CT (or xray)

53
Q

Imaging for spinal fractures

A

CT with contrast/MRI for nerve root or spinal cord injury (or x-ray)

54
Q

Imaging for thoracic injury

A

CT with contrast (or CXR with oblique views)

55
Q

Imaging for abdominal injury

A

CT with contrast (or plain flat and upright xray)

56
Q

Considerations with pts that have been abused

A 
Increased risk of teen pregnancy
Sexually risky behaviors
Abuse in future of own kids
Psych disorder as adult
Substance abuse disorders
9X more likely to be in criminal activity

X Pediatrics 2 (10 decks)

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