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Peds II > Child Abuse > Flashcards

Child Abuse Flashcards

1
Q

What are the four types of child abuse? Which is most common?

A
  • Neglect = MOST common
  • Physical
  • Sexual
  • Emotional
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2
Q

What age group is child abuse most common in?

A

<3 years

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3
Q

½ of all deaths from child abuse are in children of what age group?

A

<1 year

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4
Q

What type of bruise is especially suspicious for child abuse?

A

FACIAL

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5
Q

Bruises of what area of the body are more likely to be unintentional (3)?

A

Bony prominences:

  • Forehead
  • Knees
  • Anterior body
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6
Q

What type of physical abuse can be associated with sexual abuse?

A

Bites

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7
Q

If there is a bite mark present, what test should ALWAYS be done?

A

Swab for DNA

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8
Q

How can you differentiate a child bite mark from an adult bite mark?

A

Distance between maxillary inter-canines is 2.5-3 cm for ADULTS

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9
Q

What three types of orofacial injuries are commonly seen/most concerning?

A
  • Frenulum tears
  • Skull fractures/facial fractures
  • Ear bruising
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10
Q

What is the SECOND most common injury seen with physical abuse?

A

Fractures

- Often associated with other injuries

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11
Q

What three types of fractures are especially suspicious for abuse, and in what populations?

A
  • Rib fracture in <1 year
  • Long bone fracture in non-walking
  • Multiple fractures in different stages of healing
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12
Q

What are the two most common types of fractures seen with abuse?

A
  • Metaphyseal lesion of long bones

- Rib fractures

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13
Q

What is the most common cause of lethal child abuse?

A

Abusive Head Trauma (AHT)

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14
Q

What other finding is often seen with Abusive Head Trauma (AHT)?

A

Retinal hemorrhage

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15
Q

Parents who seek care for localized swelling, lethargy or asxs post-injury = injury is more likely due to what?

A

Unintentional

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16
Q

Parents who do NOT seek care until breathing issues, apnea, seizures, lifeless = injury is more likely due to what?

A

ABUSE

- Wait to have child seen until severe/too late

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17
Q

What type of IC bleed is often due to unintentional trauma?

A

Epidural hemorrhage

18
Q

What two types of IC Bleeds are often due to AHT?

A
  • Subdural hemorrhage (SHD)

- Subarachnoid hemorrhage (SAH)

19
Q

What type of IC bleed presents in almost ALL fatal causes of AHT?

A

Subarachnoid hemorrhage (SAH)

20
Q

If a patient presents with complex, depressed skull fracture, what condition should you suspect?

A

Subarachnoid hemorrhage (SAH)

21
Q

With what type of abuse is emotional or behavioral changes often seen, rather than physical?

A

Sexual abuse

  • More common in females
  • Males less likely to report
22
Q

What diagnostic test should always be performed if you suspect sexual abuse?

A

Collect forensic evidence (especially if within 24 hours)

23
Q

What two types of abuse involve current AND future harm (actual vs. potential)?

A
  • Neglect

- Emotional

24
Q

What four differential diagnoses should you consider for bruising due to abuse?

A
  • ASA ingestion = bruising
  • Mongolian spots
  • Vasculitis
  • Coagulopathy
25
Q

In what two ways can you differentiate Mongolian spots from bruising due to abuse?

A
  • Mongolian spots lack swelling or tenderness

- Mongolian spots fade over MONTHS/YEARS (not days)

26
Q

If bruising is present and there is NO witnessed abuse, what lab should you consider ordering?

A

Coagulation studies/CBC

27
Q

How can you differentiate Vasculitis from bruising due to abuse? What condition might you consider for Vasculitis?

A

HSP

- HSP is seen on LE + arthralgias, abdominal pain

28
Q

What three differential diagnoses should be considered for fractures due to abuse?

A
  • OI/Brittle Bone
  • Nutritional deficiency
  • Pathologic fracture (neoplasm)
29
Q

What differential diagnosis should be considered for burns due to abuse?

A

Impetigo

30
Q

How can you differentiate Impetigo from cigarette burns due to abuse (3)?

A

Cigarette burns are…

  • Deeper
  • More defined/uniform shape
  • SCAR (Impetigo does not scar)
31
Q

What condition involves sensory, automatic neuropathies → decreased sensation to pain, temp.?

A

Congenital Pain Insensitivity

32
Q

What five injuries should raise HIGH suspicion for abuse?

A
  • Bruises on trunk/ear/neck
  • Long bone fractures if non-ambulatory
  • Rib fractures in <1 year
  • Subdural hemorrhage (SHD) in <1 year
  • Hollow viscous injuries
33
Q

What five history components should raise HIGH suspicion for abuse?

A
  • Inconsistent with injury
  • Change in MOI
  • Vague/no history
  • Injury blamed
  • History of prior bruising or orofacial injury
34
Q

What four signs of parent behavior should raise HIGH suspicion for abuse?

A
  • Delay in seeking medical care
  • Lack of appropriate concern for injury severity
  • Abnormal emotions
  • Partial confession
35
Q

What is the recommended initial imaging? What imaging should then be performed next?

A

Initial = XRAY

- Then CT with contrast (without contrast if skull)

36
Q

Skeletal survey should be ordered if <6 months with…

A

ANY bruising except if reported fall OR single bruise

37
Q

Skeletal survey should be ordered if <9 months with…

A

1+ bruises ANY location

38
Q

Skeletal survey should be ordered if <1 year with…

A

1+ bruises not on bony prominences (cheeks, eyes, ears, neck, torso, upper arms/legs, genitals/buttock, hands/feet)

39
Q

Skeletal survey should be ordered if <2 years with…

A

4+ bruises not on bony prominences (ears, neck, torso, genitals/buttock, hands/feet)

40
Q

What two groups should always be called for abuse cases?

A
  • CPS
  • Police

Reporting is mandated in ALL 50 states

41
Q

If a patient has suffered/survived child abuse, they are at increased likelihood for what five things?

A
  • Criminal activity
  • Teen pregnancy
  • Risky sexual behaviors
  • Substance use
  • Future abuse

Peds II (12 decks)

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