Child Abuse Flashcards
What are the four types of child abuse? Which is most common?
- Neglect = MOST common
- Physical
- Sexual
- Emotional
What age group is child abuse most common in?
<3 years
½ of all deaths from child abuse are in children of what age group?
<1 year
What type of bruise is especially suspicious for child abuse?
FACIAL
Bruises of what area of the body are more likely to be unintentional (3)?
Bony prominences:
- Forehead
- Knees
- Anterior body
What type of physical abuse can be associated with sexual abuse?
Bites
If there is a bite mark present, what test should ALWAYS be done?
Swab for DNA
How can you differentiate a child bite mark from an adult bite mark?
Distance between maxillary inter-canines is 2.5-3 cm for ADULTS
What three types of orofacial injuries are commonly seen/most concerning?
- Frenulum tears
- Skull fractures/facial fractures
- Ear bruising
What is the SECOND most common injury seen with physical abuse?
Fractures
- Often associated with other injuries
What three types of fractures are especially suspicious for abuse, and in what populations?
- Rib fracture in <1 year
- Long bone fracture in non-walking
- Multiple fractures in different stages of healing
What are the two most common types of fractures seen with abuse?
- Metaphyseal lesion of long bones
- Rib fractures
What is the most common cause of lethal child abuse?
Abusive Head Trauma (AHT)
What other finding is often seen with Abusive Head Trauma (AHT)?
Retinal hemorrhage
Parents who seek care for localized swelling, lethargy or asxs post-injury = injury is more likely due to what?
Unintentional
Parents who do NOT seek care until breathing issues, apnea, seizures, lifeless = injury is more likely due to what?
ABUSE
- Wait to have child seen until severe/too late
What type of IC bleed is often due to unintentional trauma?
Epidural hemorrhage
What two types of IC Bleeds are often due to AHT?
- Subdural hemorrhage (SHD)
- Subarachnoid hemorrhage (SAH)
What type of IC bleed presents in almost ALL fatal causes of AHT?
Subarachnoid hemorrhage (SAH)
If a patient presents with complex, depressed skull fracture, what condition should you suspect?
Subarachnoid hemorrhage (SAH)
With what type of abuse is emotional or behavioral changes often seen, rather than physical?
Sexual abuse
- More common in females
- Males less likely to report
What diagnostic test should always be performed if you suspect sexual abuse?
Collect forensic evidence (especially if within 24 hours)
What two types of abuse involve current AND future harm (actual vs. potential)?
- Neglect
- Emotional
What four differential diagnoses should you consider for bruising due to abuse?
- ASA ingestion = bruising
- Mongolian spots
- Vasculitis
- Coagulopathy
In what two ways can you differentiate Mongolian spots from bruising due to abuse?
- Mongolian spots lack swelling or tenderness
- Mongolian spots fade over MONTHS/YEARS (not days)
If bruising is present and there is NO witnessed abuse, what lab should you consider ordering?
Coagulation studies/CBC
How can you differentiate Vasculitis from bruising due to abuse? What condition might you consider for Vasculitis?
HSP
- HSP is seen on LE + arthralgias, abdominal pain
What three differential diagnoses should be considered for fractures due to abuse?
- OI/Brittle Bone
- Nutritional deficiency
- Pathologic fracture (neoplasm)
What differential diagnosis should be considered for burns due to abuse?
Impetigo
How can you differentiate Impetigo from cigarette burns due to abuse (3)?
Cigarette burns are…
- Deeper
- More defined/uniform shape
- SCAR (Impetigo does not scar)
What condition involves sensory, automatic neuropathies → decreased sensation to pain, temp.?
Congenital Pain Insensitivity
What five injuries should raise HIGH suspicion for abuse?
- 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
What five history components should raise HIGH suspicion for abuse?
- Inconsistent with injury
- Change in MOI
- Vague/no history
- Injury blamed
- History of prior bruising or orofacial injury
What four signs of parent behavior should raise HIGH suspicion for abuse?
- Delay in seeking medical care
- Lack of appropriate concern for injury severity
- Abnormal emotions
- Partial confession
What is the recommended initial imaging? What imaging should then be performed next?
Initial = XRAY
- Then CT with contrast (without contrast if skull)
Skeletal survey should be ordered if <6 months with…
ANY bruising except if reported fall OR single bruise
Skeletal survey should be ordered if <9 months with…
1+ bruises ANY location
Skeletal survey should be ordered if <1 year with…
1+ bruises not on bony prominences (cheeks, eyes, ears, neck, torso, upper arms/legs, genitals/buttock, hands/feet)
Skeletal survey should be ordered if <2 years with…
4+ bruises not on bony prominences (ears, neck, torso, genitals/buttock, hands/feet)
What two groups should always be called for abuse cases?
- CPS
- Police
Reporting is mandated in ALL 50 states
If a patient has suffered/survived child abuse, they are at increased likelihood for what five things?
- Criminal activity
- Teen pregnancy
- Risky sexual behaviors
- Substance use
- Future abuse
