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Peds II Final > Child Abuse > Flashcards

Child Abuse Flashcards

1
Q

Child abuse most often occurs

A

<3 YO (49% <12mo)

injury to infants under 6 mo is left often due to battery

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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 perpetrator

A

parents

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4
Q

Risk factors for babies/children

A 
medical condition (learning disability, premature, ADHD, etc.)
non-biologic caregiver
age (<3 YO)
Prior abuse
unplanned pregnancy, unwanted child
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5
Q

Categories of child abuse

A

neglect (75%)
physical (44%)
Sexual (8.5%)
Emotional (7%)

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6
Q

Characteristics of unintentional bruising

A

bony prominences: forehead, knees, front of body

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7
Q

Characteristics of inflicted bruising

A
  • central bruising: butt, back, trunk, genitalia, inner thigh, neck, ears
    nonmobile babies, or <6mo
    -Multiple bruises in clusters
    -human bite marks
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8
Q

Types of bruises

A

handprint or oval finger marks
loop marks (rope, wire, cord)
linear (whipping, paddling)
belt marks (broad band, may end in horse-shoe shape)
ligature marks: neck, wrist, ankle, corners of mouth
Bruising on pinna: blow to the side of head

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9
Q

Bruising bites

A

can be associated w/ sexual abuse
circular area ecchymosis and superficial abrasions
central clearing/petechia

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10
Q

How to differentiate between child and adult bite

A

distance between maxillary inter-canines 2.5-3cm in adults

swab for DNA

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11
Q

When to expect physical abuse burn

A

children <5 w/o unintentional spill pattern
brands
immersion (stocking globe, butt, legs)
cigs (3rd degree, heal slow w/ scarring, dorsa of hands/feet or face)

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12
Q

Common form of abuse in 50% of abused children

A

orofacial injury

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13
Q

Types of orofacial injuries

A

frenulum tear
lip laceration, missing/broken teeth, tongue injury, burns from forced feeding, facial/basilar skull fx, periorbital ecchymosis, ear bruising, traumatic alopecia, bruising/lichenification or scarring at corners of mouth

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14
Q

Most common physical abuse injury

A

bruise

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15
Q

second most common abuse injury

A

fracture

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16
Q

High suspicion fractures

A 
rib fx, esp. <1 yr
long bone fx in non-walking children
sternum/scapula or spinal fx
multiple fxs in different stages of healing
depressed skull fx
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17
Q

Babies will head trauma common have

A

skeletal fx (20-50%)

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18
Q

2 most common fx in abuse

A

metaphyseal lesions of long bones (injuries in infancy)

rib fx due to forceful compression of ribs while shaking (posterior ribs near costavertebral articulation)

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19
Q

Sx of sexual abuse

A

reserved, depressed, angry, regress w/ toileting

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20
Q

PE for sexual abuse

A 
thorough questioning
evaluate GU
oral exam 
STI screen
Urine pregnancy
Forensic evidence (esp. if w/i past 24 hrs)
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21
Q

Types of neglect

A

physical- food, shelter, hygiene
psych (emotion)- love, affection
Educational
medical- dental, medical care

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22
Q

Emotional neglect

A 
rejection
isolation
terrorizing
ignoring
corrupting
verbal assault
over-pressuring
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23
Q

Emotional neglect reporting

A

child @ risk from lack of supervision
medical/dental neglect despite assistance offered
failure to provide food, shelter, clothing, protection, education
domestic abuse

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24
Q

Tx for emotional neglect

A

counseling for child and parent and possible removal of child from home

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25
Q

Induced illness

A

forced ingestion- overlaps w/ Factitious Disorder Imposed on Another (Munchausen syndrome by proxy)

26
Q

Examples of induced illness

A

salt poisoning
water intoxication
Prescription and illicit drugs

27
Q

Abusive head trauma and brain injury cause

A

trauma, shaking or both

can be secondary central apnea from injury to brainstem and spinal cord during “shaking”

28
Q

Reasons people seek care for UNINTENTIONAL head injury

A

local swelling following injury
lethargy
concern for children who were asymptomatic

29
Q

Reasons people seek care for ABUSIVE head injury

A

breathing difficult
apnea
seizures
lifelessness

(they wait to be child in)

30
Q

Types of IC bleeding

A

epidural hemorrhage
subdural hemorrhage
subaracnoid hemorrhage
Retinal hemorrhage

31
Q

epidural hemorrhage

A

usually unintentional

32
Q

Subdural hemorrhage

A

USUALLY ABUSIVE
would require significant force (MVA or drop from significant height)
many will show evidence of past SDH

33
Q

Subarachnoid hemorrhage

A

present in nearly all fatal inflicted head traumas

can be seen in unintentional head trauma

34
Q

Retinal hemorrhage

A

often seen in abusive head trauma (60-85%)

less severe hemorrhage may be seen in unintentional head injury

35
Q

Signs of abusive skull fx

A

DEPRESSED SKULL

36
Q

Ddx for bruising

A

salicylate ingestion
mongolian spot
coagulopathy
vasculitis

37
Q

Ddx for burns

A

unintentional
impetigo
phytophotodermatitis

38
Q

Fx ddx

A

OI
nutritional deficiency
pathologic

39
Q

Salicylate ingestion

A

diffuse bruising
tachypnea, hyperthermia, tachycardic, hypotension
vomiting

check plasma salicylate concentration

40
Q

Mongolian spot: who?

A

african american, asian, hispanic

41
Q

mongolian spot: where?

A

lower back and butt, may extend to upper back and extremities

absence of swelling/tenderness
fade over months to years

42
Q

Vasculitis

A

purpuric rash/lesions d/t breakdown of vascular walls

HSP: usually on LE, arthralgia (knees), abdominal pain

43
Q

Coagulopathy

A

review medical hx, family hx, PE
always get coag study w/ head injury and no witness

no witness = coag study/CBC w/ diff

44
Q

Impetigo

A

infection due to staph/strep- can look like cig burn

superficial layers only, cig burns are 3rd degree and heal w/ scarring

45
Q

Phytophotodermatitis

A

burn like skin lesion when sun interacts w/ certain fruits/veggies

46
Q

fruit/veggies associated with phytophotodermatitis

A

lemons, oranges, celery, figs

47
Q

Congenital pain insensitivity

A

Decreased sensation to pain and sometimes temp

  • burns, bruises, lacerations, fractures
  • parent may not notice due to no c/o pain from child; can lead to infection
  • need thorough neuro exam
48
Q

Cupping

A

heated vessel applied to skin (middle east, asian, Latin america, eastern european)

49
Q

Coining

A

oiled coin is rubbed firmly into skin (asia) - causes petechiae and ecchymosis

50
Q

Spponing

A

wet skin is rubbed w/ spoon, causes ecchymosis (China)

51
Q

Injury w/ high association of abuse

A 
bruise on trunk, ear, neck
bruising in infants who are not cruising
long bone fx in non-walking babies
rib fx <1 yr
subdural hematomas <1yr
follow viscous injury in children <4 (ruptured bladder, bowel)
52
Q

Suspicious parent behavior

A

delay in seeking care
lack of concern
aloofness, lack of emotional attachment to child
argumentive/violent/aggressive
partial confession (“i hit him but not hard enough to do that”)

53
Q

PE for abuse

A 
(Out --> in)
clothing and hygeine
skin, bone tenderness, reluctance to use extremity
mental status
exam entire body
54
Q

Labs for abuse

A 
coag
CBC w/ diff and platelets
CMP (ALT, AST)
Amylase, lipase (pancreatic injury)
UA
Toxicology (serum and urine)
stool guaiac (not everyone: abdominal/sexual trauma)
55
Q

Dx of skull fx

A

x-ray, NON-CONTRAST CT

56
Q

Dx of spinal fx

A

x-ray, CT W/ CONTRAST, MRI for nerve root or spinal cord injury (neuro deficit)

57
Q

Dx of thoracic injury

A

CXR w/ oblique views

CT W/ CONTRAST

58
Q

Dx of abdominal injury

A

plain flat and upright x-ray

CT W/ CONTRAST

59
Q

Management of suspected child abuse

A

consult w/ others
call CPS and law enforcement!!!
mandated reporting
document!

Hospitilization? - depends on severity, not safe going home, response of CPS will be delayed

IDENTIFY OTHER CHILDREN @ RISK

60
Q

Medical records for abuse

A

hx of known previous injuries
procedures performed
labs/radio studies
statements from parents/caregivers- QUOTES
Descriptive findings including sketch online injuries/skin/fx
photographs if possible
final disposition of child (admitting/sending home)

61
Q

Screening tool for abuse

A
  1. hx consistent?
  2. care delayed?
  3. injury fit w/ developmental level of child?
  4. behavior of child, caregivers etc appropriate?
  5. Findings in accordance w/ hx
  6. other signals that make you doubt safety?
62
Q

Post abuse complications

A 
increased teen pregnancy
high risk sex behaviors
1/3 will abuse their children/partner
1+ psych disorder
1/3 substance abuse disorder
9x more likely to be involved in crime

Peds II Final (3 decks)

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