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Child Abuse 🥺 Flashcards

1
Q

What is the most common cause of lethal child abuse?

A

Abusive head trauma **!!! Must know*

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2
Q

What ethnic groups have disproportionately higher child deaths in Arizona?

A

African American

American Indian

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3
Q

What are the leading causes of death in childern ages 1-4

A
  1. Accidents
  2. Congenital malformation, chromosomal abnormalities
  3. Assault (Homicide)***
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4
Q

Who are the main perpetrators of child abuse?

A

Parents 81%

Step-parent/mom’s new boyfriend: 12%

Other adult 7%

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5
Q

What are the parental risk factors that make them more likely to become abusers?

A

Young age/single parent

Low education

Poverty

Drug/alcohol abuse

Domestic violence in household

Unrealistic expectations of baby/kid

Unrelated adult male in household (mom’s new boyfriend)

Social isolation

Hx of animal cruelty

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6
Q

What are the risk factors for babies and children that makes them more likely to get abused?

A

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

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7
Q

Who usually reports child abuse?

A

Teachers

Law enforcement

Social services

Medical personnel

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8
Q

What are the 4 types of abuse?

A

Neglect (75%)

Physical (44%)

Sexual (8.5%)

Emotional (7%)

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9
Q

Where are the normal places for a little kid to have bruises?

A

Bony prominences:

Forehead

Knees

Front of body

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10
Q

What are some characteristics of bruising that are suspicious for child abuse?

A

Central bruising- buttocks, back, trunk, genitals, inner thighs, neck, EARS**👂🏻👂🏻

Bruising in babies that aren’t mobile on their own or <6 months

Clustered bruises

Human bite marks

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11
Q

Are ear bruises ever normal?

A

NO

She said this soooo many times

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12
Q

What kind of shapes would bruises appear if they were caused by abuse?

A

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

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13
Q

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?

A

Measure the distance between the maxillary inter-canines. (2.5-3cm in an adult)

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14
Q

Should you swab a bite mark for DNA

A

Yes

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15
Q

What kind of abuse are bite marks associated with

A

Sexual abuse

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16
Q

What kind of pattern would make you think that a baby burned itself on accident?

A

Irregular, top-down pattern like if a baby pulled a hot pot of soup down on themselves

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17
Q

What are some suspicious burns?

A

Brands- imprint from an object

Immersion- stocking glove, buttocks, leg

Cigarette burns

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18
Q

Cigarette burns tend to be _____ degree and heal (fast/slow) with ______

A

Third degree**

Slowly with scarring**

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19
Q

Where are cigarette burns usually located on a baby

A

Back of hands/feet

Face

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20
Q

What should a frenulum tear make you think?

A

Force feeding

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21
Q

Is it common to see orofacial injuries in abused children?

A

Yes, occurs in up to 50% of abused kids

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22
Q

What are some examples of orofacial injuries that were caused by abuse?

A

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

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23
Q

What can cause bruising/lichenification at corners of mouth

A

Being gagged

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24
Q

What is the second most common injury in physical abuse after bruises?

A

Fractures

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25
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
26
What causes depressed skull fractures?
Being struck by something (not from falling down) | 🔨🏌️‍♂️⚱️
27
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)
28
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
29
Are boys or girls more likely to be sexually abused?
Girls, but boys are less likely to report so this is prob skewed
30
Is it OK to ask a kid if they’re being sexually abused if their mom is sitting right there?
Yes, you want the child to be as comfortable as possible
31
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
32
What do you NEED to do if you suspect sexual abuse?
Collect forensic evidence, especially if the abuse occurred in the last 24 hrs
33
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)
34
What is neglect?
Failure to provide a child basic needs
35
What are some examples of neglect?
Physical- food, shelter, hygiene, supervision Psychological/emotional Educational- enrollment at school, addressing special needs Medical- timely medical/dental care
36
What are some ways a child can be emotionally neglected?
Rejection Isolation Terrorizing- setting unrealistic expectation, threatening to hurt child, pets, or loved ones Ignoring Corrupting- encouraging bad behavior Verbal assault- name calling, sarcasm, humiliating Over-pressuring- overly advanced expectations
37
When do you need to report neglect to CPS?
If there is malicious intent or potential for harm: - child has no supervision - Medical/dental neglect despite offered assistance - failure to proved adequate food, shelter, clothing, protection and education - domestic abuse
38
Does CPS take the child out of the home 100% of the time?
No, sometimes it may involve counseling for parent and child
39
What is induced illness?
Forced ingestion by children | Overlaps with fictitious disorder imposed on another aka Munchausen by proxy
40
What are some ways a parent can cause induced illness
Salt poisoning Water intoxication Prescription/illicit drugs
41
Is it common to miss head traumas at the initial evaluation of the child?
Yes up to 30%
42
What are some reasons that caretakers bring children to the hospital after a head injury that was truly an accident?
Localized swelling following injury Lethargy Concern for children who are asymptomatic
43
What are the reasons caretakers will take a child to the ER after the child had an abusive head injury?
Breathing difficulties Apnea Seizures Lifelessness (Aka they wait until things look really grim)
44
Which kind of intracranial bleed happens more frequently with accidental head trauma?
Epidural hemorrhage
45
What kind of force is necessary to cause a subdural hemorrhage?
Significant force, such as MVA or drop from significant height. They are not typically accidental.
46
A significant amount of infants with subdural hemorrhage will show evidence of ______
Past subdural hemorrhage
47
What kind of intracranial bleed is present in nearly ALL fatal inflicted head traumas?
Subarachnoid hemorrhage
48
What are you looking for in the eye exam if a child has suffered a head trauam?
Retinal hemorrhage
49
Which has more severe retinal hemorrhage: abusive trauma or accidental injury
Abusive trauma
50
What kind of skull fractures should make you suspect abuse?
Complex, depressed*** skull fractures
51
What are 4 other possible causes of bruising that should be on your DDx (other than abuse)
Salicylate injection (aspirin poisoning) Mongolian spots Coagulopathy Vasculitis
52
If a child comes in with bruises, what plasma test do you NEED to run?
Salicylate concentration ****** EATING ASPIRIN CAN CAUSE BRUISES 💊💊💊💊💊💊
53
What kind of symptoms occur with salicylate ingestion?
Diffuse bruising Tachypnea, hyperthermia, tachycardia, hypotension Vomiting
54
What ethnicities more commonly get Mongolian spots?
African American Asian Hispanic
55
Where do Mongolian spots typically appear?
Lower back Buttocks Might extend to upper back and extremities
56
How long does it take for Mongolian spots to fade?
Months to years | Unlike actual bruises that fade in a few days
57
How will a child with henoch-schonlein purpura present?
Purpura on lower extremities Arthralgia (knees and ankles) Abdominal pain
58
When do you need to do coagulation studies to r/o a coagulopathy?
If there was NO witnessed abuse mom says “Idk what happened these bruises just appeared” If abuse was witnessed, bleeding/coagulation studies may not be necessary
59
What are 3 possible explanations for suspicious fractures that should be on your ddx?
Osteogenesis imperfecta Nutritional deficiency- Vitamin D Neoplasm- Pathologic fractures
60
What is something that can cuase lesions that look A LOT like cigarette burns?
Impetigo********
61
How can you tell a cigarette burn apart from impetigo?
Impetigo: superficial layers only** Cigarette burn: typically 3rd degree and heal with scarring***
62
What is a totally innocent cause of burn-like lesions that Ms. Sears said happened to her kid?
Phytophotodermatitis *** Kid spills lemon/orange/celery/fig juice on their skin and then plays in the sun= burn-like lesions 🍊☀️🍋🌞🔥🔥🔥
63
What is a super rare genetic condition that could explain why a kid looks like it was beaten?
Congenital pain insensitivity Kid doesn’t feel pain/temperature and walks around burning, bruising, fracturing, etc and doesn’t ever complain. Wounds end up getting infected
64
What are 3 cultural practices that can result in wounds that look suspicious
Cupping- middle eastern, Asian, Latin America, Eastern European people people Coining- SE Asian peopel rub oiled coin on skin Spooning- Chinese people rub skin with a spoon
65
What is important when you are talking to parents/caregivers when there is possible abuse?
Use non-accusatory language when speaking with them
66
Let’s look at a list of 6 injuries with a high association with abuse
Bruises of trunk, EAR, and neck Bruises in infants who are not cruising Long bone fractures in non-walking babies Rib fractures in babies <1 yr Subdural hematoma in baby <1yr Hollow Viscous injury in children <4 yrs (like a ruptured bladder/bowel)
67
What are some things that should raise suspicion when a parent is telling the story of how the child got hurt?
History inconsistent with injury Mechanism of injury changes (ex told triage nurse something else) History is vague or not offered (“I have no idea what happened” Injury is blamed on younger siblings or self-inflicted Implausible history History of bruising or orofacial injury in non-cruising infant Injury attributed to in-home resuscitation efforts- “i did CPR on him that why he has rib fractures”
68
What kind of parent behavior is suspicious when they bring their kid in to the ER?
Inappropriate delay in seeking medical care Lack of appropriate concern for severityof injury Aloofness, lack of emotional attachment to child (ex: playing on phone ) Argumentative, aggressive, violent with staff Partial confession: “I hit him, but NOT hard”
69
What kind of questions should you NOT ask children when you’re interviewing them?
Yes or No questions
70
If a child is too young to recall timing, what is something you can ask them instead?
Use historical details. Ex: “Was this before or after Christmas?”
71
What kinds of questions should you ask children when you’re interviewing them?
Open-ended. Who, What, Where When
72
Why do you need to look at a child’s clothing when you’re examining them?
Make sure it’s weather appropriate and clean
73
What do you need to do during your physical exam of a child you suspect may be abused?
Palpate EVERYWHERE and look for tenderness: kid might be afraid to tell you when something hurts Ask them to walk/jump around and look for a reluctance to use an extremity
74
What labs do you need to do if you suspect abuse?
Coagulation studies if abuse was NOT witnessed** CBC w diff CMP including ALT,AST for Hepatic Injury Amylase, lipase for pancreatic injury UA Toxicology (serum and urine) Stool guaiac (abdominal/sexual trauma)
75
What kind of imaging needs to be done for skull fractures?
NON-contrast CT X-ray
76
What kind of imaging needs to be done for spinal fractires?
CT WITH Contrast*** MRI for nerve/spinal cord injury*** X ray
77
What kind of imaging needs to be done for a thoracic injury’?
CT WITH contrast** CR with oblique views
78
What kind of imaging needs to be done for an abdominal injury?
CT with IV contrast** (not oral) Plain flat AND upright X-ray (looking for free air)
79
If you suspect an occult fracture, but X-ray has not shown anything, what other kind of imaging study can be done?
Bone scan***
80
What to you need to do EVERY time you suspect child abuse
Call CPS and law enforcement **** Consult with other healthcare providers Documentation
81
Are PAs mandated reporters
Yes
82
When do you need to admit a child?
If not considered safe to go home with parent/caregiver If CPS response will be delayed
83
Why do you need to find out if a child has siblings?
You need to identify if any OTHER children are at risk*********
84
What should your medical records include if you see a child with abuse?
Hx of any known previous injuries (call their PCP) Procedures you performed and why Labs/studies Statements from parents *IN QUOTATIONS** Descriptive findings including a sketch outlining injuries ✏️ Photographs if possible 📸 Final disposition of child
85
What are the 6 questions you need to consider when screening for child abuse in the ER?
1. Is the history consistent with what you’re seeing? 2. Was seeking care unnecessarily delayed? 3. Does the injury fit with the developmental level of the child? 4. Is the behavior of the child, the parents, and their interaction appropriate? 5. Are findings of the head-to-toe exam in accordance with the history? 6. Are there any other signals that make you doubt the safety of the child or other family members? **if yes to any of these= CPS now**
86
When a child has suffered abuse, what kinds of behaviors are they more likely to exhibit as they grow up?
NINE TIMES more likely to be involved in criminal activity 👮🏼‍♀️***** Teen pregnancy 🤰🏻 1/3 will abuse their own children and are at risk of domestic partner abuse Psychological disorders More than 1/3 will develop a substance abuse disorder 💉💊
87
Why do abused children need psychotherapy?
To learn how to trust To teach what normal behaviors and relationships are To learn conflict management Boost self esteem

Peds Rotation (13 decks)

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