Child abuse Flashcards
T/F
We are mandated reporters
T
What percent of children that die of abuse are under the age of 4?
70%
What are the most common types of injuries in abuse cases?
craniofacial, head, face, neck
What are some of the consequences of child abuse?
More likely teen pregnancy More likely sexual risk taking More likely substance problem More likely psychological disorder More likely criminal activity
What are some of the risk factors for child abuse?
Family violence Psychological factors in guardian Substance abuse in guardian Family stress Child with special needs Single parents
What is the definition of abuse?
When a child’s parent, guardian or caretaker acts in the following ways:
- -Causes non-accidental injury
- -Uses a child for sexual purposes or involves a child in sexual acts
- -Harms a child’s mental or social development or causes severe emotional harm
What are the key components for documentation of suspected abuse?
Who was caring for child What events preceded the injury Any witnesses What was the child's reaction What did the caregiver do When did the injury occur Where did it occur
What are RED flags to be aware of in the history?
Injury incompatible with the child’s developmental abilities
Does the extent of injury make sense with the history
Absent, changing or evolving history
Delay in seeking medical care
Triggering event that precipitates loss of control in caregiver
Family crisis or stress
Prior history of abuse in caregiver
Where will you find evidence of abuse?
Ears- pinch marks on both sides of ears Triangle of safety- ears, side of face, neck and top of shoulders Inner aspects of arms Back and side of trunk except directly over spine Black eyes (bilateral especially) Soft tissue of cheeks Intra-oral injuries Forearms Chest and abdomen Any groin or genital injury Inner aspects of thighs Soles of feet
What is the most common type of injury in an abused and in non-abused children?
bruising
Bruising is highest in…
Precrusiers, cruisers or walkers?
walkers
What are the non-intentional locations for bruises?
Forehead
Vertex of chin
Elbows
Knees/Shins
What are the intentional locations for bruises?
Ears Neck Upper arms/legs Abdominal wall Buttocks/anus Genitalia
Time taken for appearance and resolution of bruise is dependent upon:
Attachment of tissue injured Thickness of tissue injured Type of injuring force Depth of the injury Vascularity of the injured/surrounding tissues Underlying color of the injured person's skin Age of patient Underlying medical conditions
What do colors of bruises mean?
Red/blue/purple- generally associated with recent bruising
Yellow/brown/green- generally associated with older healing bruising
Any of these colors can be observed in a bruise at any time before it fully resolves
What is the importance of bruise dating?
Assessment of the age of a bruise in children is inaccurate and has no scientific basis
What is patterned bruising?
the force of objects leaving a pattern on the soft tissue
Inflexible objects- may produce short linear bruises, bruising will reflect impact in one plane and should not follow curvature of affected region
Flexible objects- may cause a bruising pattern that follows the curvature of the body, commonly caused by extension cords, belts, ropes
What coagulation disorders mimic bruising?
Leukemia Vit K deficiency Von Willebrand's Thrombocytopenia Hemophilia Factor 8 deficiency
What other disorders mimic bruising?
Dermal melanosis Erythema multiforme Purpura fulminans Phytophotodermatitis Allergic dermatitis Insect bites Self inflicted bruises Abdominal striae
What are the characteristics of bite injuries?
- -result from crushing pressure of the teeth as well as cutting from incisors and other teeth as the drag across skin
- -resulting cutaneous finding depends on force, duration, degree of movement between teeth and soft tissue bitten
- possible central ecchymosis related to either negative pressure of suction or tongue thrust, disruption of blood vessels enclosed within the area of the bite
What are the characteristics of adult-inflicted bites?
often only distinct in one arch
avg maxillary intercuspid distance of 33mm
teeth tend to be rectangular
What are the characteristics of child-inflicted bites?
bites are often distinct in both arches
intercuspid distance of less than 30 mm
teeth tend to be more rounded
What are the characteristics of animal-inflicted bites?
generally tear skin
much narrower arch with elongated A-P aspect than human bites
Where are the most common locations of human bites?
occur most frequently on upper extremities
may occur during play, fights, sport, sex
developmental biting behavior in preschool age often seen with frustration/anger
Adults may bite child to stop biting behavior
What are the characteristics of liquid burns?
Scalding is most frequent form of abuse More than 80% of abusive scald burns are from tap water Observed patterns --Immersion patterns --Skin-sparing patterns of immersion
What are the characteristics of contact burns?
Configured by the burning object
Abusive injuries often more sharply defined than accidental ones
What do intentional cigarette burns look like?
Firm contact typically produces a sharply defined circular, 3rd degree burn
Approx. 5-10mm in diameter
Often on exposed areas- hands, feet, head and neck
What are the characteristics of accidental cigarette burns?
Typically causes only superficial brush burns
What are the characteristics of oral trauma?
Blunt impact
Insertion of object into mouth
Sexual abuse- petechiae, ulcerations, infection–oropharyngeal gonorrhea, condyloma
Burns with hot liquids/caustic agents
Tongue lacerations may be caused by bite marks
Why do frenum tears occur?
Non-accidental trauma
–slap/punch to mouth
–forced feeding with spoon, pacifier, bottle nipple, forced oral sex
Any non-abulatory child with a frenum tear should be evaluated for abuse
What is the definition of dental neglect?
Willful failure of parent to follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection
What are the terms of being a mandated reporter?
Required to make a report to child protective services or law enforcement if you suspect abuse/neglect
You do not have to have proof
You do not have to conduct a full investigation
You can’t be held civilly or criminally liable
How to make a report?
Name, address and age of victim Name and address of guardian Name and address of person you suspect is abusing or neglecting the victim The reason you suspect abuse or neglect Any other helpful information You may report anonymously
