Child Abuse and Child Sexual Abuse Flashcards

1
Q

Define child abuse

A

The act of harm to a child by parent, relative, sibling, carer or other person
Child treated by adult in a way that is unacceptable in given culture

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2
Q

Define child sexual abuse

A

Sexually immature children participate in sexual activities they do not fully understand, to which they are unable to give informed consent and that violates social taboos of family roles

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3
Q

Types of child abuse

A
Physical - non-accidental injury
Sexual
Emotional - psychological
Neglect
- not necessarily deliberate - may not have intelligence, time and resources to give to children
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4
Q

Statistics of child abuse

A

100 children die every year

75% offenders known to victim

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5
Q

Child abuser features

A
Most male
Often abused themselves
May abuse many different victims
Abuse may occur over long periods
May target both boys and girls
Often work and live near children
Have position of trust
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6
Q

Common social factors of child abuse

A
Child often abused by close relative
Family tends to be low income group
Family often insecure or unstable
Hx of social problems in abusers
Hx of psychiatric problems
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7
Q

Typical victim of child sexual abuse

A
Less than 2 years old - unable to stand up or report
Boys more frequent
Child often first born
Child often illegitimate
Unplanned or unwanted pregnancy
Congenital defect or abnormality
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8
Q

Problems with diagnosing child abuse

A
Underdiagnosis
- late or missed
- escalating abuse can lead to death of child
- public outrage
Overdiagnosis
- infringes rights of family
- public outrage
Correct diagnosis is difficult
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9
Q

Ethical considerations when exanimating a child

A

Patient autonomy
- patient/parent/guardians’ right to self determination
- make their own informed choices
Beneficence
- Dr must act in patient’s best interests
Non-maleficence
- first do no harm
Justice - Dr must be balance, fair and non-judgemental

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10
Q

Fully informed consent requires

A

Disclosure
- Dr must supply patient with all necessary info to make autonomous decision
- facts, nature, benefits v limitations, alternatives
- implications and consequences
Capacity
- patient or guardian must understand
Voluntariness
- right to decide freely without undue influence, coercion or threat

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11
Q

Age of Legal Capacity (Scotland) Act 1991

A

Person under the age of 16 shall have legal capacity to consent to surgical, medical or dental procedure or treatment
Where in the opinion of a qualified medical practitioner they are capable of understanding the nature and possible consequences of procedure or treatment

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12
Q

Patterns of injury in child abuse

A
Bruising
- multiple ages
- fingertips
- difficult to explain
- mouth, lips ears
Biting
- pets may bite child 
- human bit more circular
- may be from other children
Burning and scalding
- round cigarette burns
- multiple thermal burns
Fractures
- multiple and varying age
- skull, ribs, long bones on limb
- spiral x-ray appearance
Internal injuries
- head injury from impact or shakin
- visceral injury from punching and kicking
Torn frenulum of lip
- from forcible feeding
Hair pulling
Friction burns from dragging
Binding marks
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13
Q

Features of impact head injury

A
Scalp injury
Skull fracture
Subdural haemorrhage
Cerebral oedema
Diffuse axonal injury
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14
Q

Features of shaking head injury

A
No external sign
Subdural haemorrhage
Cerebral oedema
Diffuse axonal injury
Retinal haemorrhages
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15
Q

Visceral injury seen in child abuse

A

Rupture of spleen or liver
Intestinal perforation - duodenum
Mesenteric tears

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16
Q

Causes of asphyxia in children

A
Strangulation
Soft smothering
Overlaying
Positional
Petechiae rare in infancy
17
Q

Bone diseases that can mimic NAI

A

Osteogenesis imperfecta
Cortical hyperostosis
Congenital bone malformations

18
Q

Skin disease than can mimic NAI

A
Chicken pox
Dermatitis
Vaccination marks
Birthmarks
Scurvy
Alopecia
19
Q

Blood disorders that can mimic NAI

A

Haemophilia
Thrombocytopenia
Leukaemia
Florid bruising after minor trauma

20
Q

Child abuse clues

A
Delay in seeking medical attention
Attendance at unusual time or place
Vague or inconsistent hx
Hx incompatible with injury
Inappropriate parental behaviour
Abnormal behaviour in child