Child abuse Flashcards
Types of child abuse?
Physical Emotional Sexual Neglect Munchausen syndrome by proxy
MC child abuse?
Neglect (hardest to prove/document)
Munchausen syndrome by proxy is?
Caregiver reports/causes factitious S/S in child
Proof of physical abuse?
Bruises - varying stages of healing/unusual sites
Non-ambulatory infants
Injury patterns - suggestive
Burns - circumferential/immersion or cigarette
Bruises on bony prominences is Abuse or NL?
NL
Bone Fx sites suggestive of abuse?
Rib
Metaphyseal (Arm twist)
Scapular
Vertebral
Injuries MC found in infants/toddlers?
Abdominal injuries
Leading cause of mortality from physical abuse?
Head injuries
Shaking or blunt impact abuse may cause?
Subdural or retinal hemorrhages
DDx of physical abuse?
Mongolian spots
Cultural practices
Bleeding dyscrasias
Brittle bone Dz (Osteogenesis imperfecta)
NL areas to find injury sites?
Forehead along brow Nose/mouth Occipital region - along back of head (Crown) Upper buttocks - iliac crest Shins/Knees/Elbows Spinal protuberances
Stages of bruising colors/days?
Red - 0-2d Blue/Purple - 2-5d Green - 5-7d Yellow - 7-10d Brown - 10-14d Gone - 2-4w
Fx types suggesting abuse?
Spiral
Bucket handle
Unlikely bones to be Fx accidently?
Scapular Posterior Rib Fx Spinous process/vertebral Skull (Non-linear) Sternal Fx
Youngest age to perform skeletal survey?
<3yo
Skeletal survey Bone healing XR appearances/days?
1-2w = New periosteal bone/callus 2-3w= Lose Fx line - Callus matures to trabecular 3-6w= Callus more dense >6w= Subtle, fusiform, sclerotic thickening
Shaken baby syndrome triad?
Retinal Hemorrhage
Subdural Hematoma
Brain swelling
Other interview indicators of physical abuse?
Wary of adult contact Afraid to go home/caregiver Withdrawn Aggressive Inappropriate clothing for weather Moves uncomfortably Controlling parents or physically directive
Sexual abuse Pts may present w/?
Recurrent UTIs
Hypersexual (Precocious sexual behavior)
Guilt/low self esteem
When should a sexual assault kit be used to evaluate pt?
Trauma w/in last 72h
Interview clues of sexual abuse?
Advanced sexual knowledge/Promiscuity Sudden school difficulties Self imposed social isolation Avoids physical contact Depression SI/attempt Night-terrors/Nightmares Runaway
Emotional abuse presents as?
FTT/withdrawn/untrusting Depression/poor bonding Low self esteem/SI Sleep issues Somatic complaints Excess anger/aggression
Behavioral indicators of emotional neglect?
Habit d/o
Antisocial/Destructive
Developmental delay
Behavior extremes
Neglect may present as?
FTT (type I growth deficit -wgt low (head/hgt NL)
Behavioral indicators of neglect?
Self destructive Beg/steal food Constant fatigue Adult responsibilities/concerns assumed No caretaker at home Parents not engaged/doesn't pay attention
TXT/Resources for mgmt of abuse?
Thorough Hx
Complete PE - Trauma w/in 72h
CPS/Family advocacy
