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Pediatrics > Child Abuse and Neglect > Flashcards

Child Abuse and Neglect Flashcards

1
Q

what is the Child Abuse Prevention Act (CAPTA)?

A
  • federal funding to states in support of prevention, investigation, prosecution and information in prevention of child abuse
  • Sets forth a minimum definition of abuse and neglect
  • Any recent act or failure to act - death, physical emotional harm, sexual abuse, exploitation, risk of harm; < 18 y/o; inflicted by parent/caretaker who is responsible for child’s welfare
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2
Q

4 Major Categories of child abuse

A
  1. Neglect & Abandonment
    - Neglect - when not due primarily to lack of financial means
    - Neglect - both actual and potential harm
  2. Physical Abuse
  3. Sexual Abuse
  4. Emotional or Psychological Abuse
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3
Q
  • intentional use of physical force that can result in physical injury
  • Examples include hitting, kicking, shaking, burning, or other shows of force against a child.

what type of abuse?

A

Physical abuse

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4
Q

involves pressuring or forcing a child to engage in sexual acts. It includes behaviors such as fondling, penetration, and exposing a child to other sexual activities.

what type of abuse?

A

sexual

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5
Q

behaviors that harm a child’s self-worth or emotional well-being. Examples include name-calling, shaming, rejecting, withholding love, and threatening.

what type of abuse?

A

emotional abuse

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6
Q

failure to meet a child’s basic physical and emotional needs. These needs include housing, food, clothing, education, access to medical care, and having feelings validated and appropriately responded to.

what type of abuse?

A

neglect

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7
Q

Any intentional touching, either directly or through clothing, of any part of another person’s body by the actors sex organs, where the victim is not married to the actor, and the touching is done for the purpose of gratifying the sexual desire of either party, involving: breasts, buttocks, anus , any sex organs of another person

A

Sexual Contact

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8
Q

Involves penetration, however slight, of the female sex organ by the male sex organ or contact between the sex organs of one person and the mouth or anus of another person

A

Sexual Intercourse

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9
Q

Involves penetration, however slight, of the female sex organ or of the anus of any person by an object for the purpose of degrading or humiliating the person so penetrated or for gratifying the sexual desire of either party

A

Sexual Intrusion

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10
Q
  • Allowing a child to drink alcohol or use illegal drugs
  • Making, ingesting, or distributing illegal drugs in the presence of a child
  • Exposing a fetus to illegal drugs or other substances while pregnant
A

substance abuse

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11
Q

Lack of proper medical care or inappropriate care

A

medical abuse

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12
Q
  • Adult caregiver makes a child appear mentally or physically ill or impaired by either fabricating the symptoms or actually causing harm to the child, in order to gain the attention of medical providers and others
  • Adult caregiver systematically misrepresents symptoms, fabricates signs, manipulates lab tests, or even purposely harms the child (poisoning, suffocation, infection or physical injury)
  • Caretaker (usually mom) either stimulates or creates the symptoms or signs of illness
A

Munchausen Syndrome by Proxy

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13
Q

majority of deaths (80%) by child abuse are of kids what age?

A

< 4 years old

69% - < 12 mo
85% - < 3 y/o

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14
Q

Nearly ½ of child abuse occur among children with what history along with contact with CPS already?

A

prior referral

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15
Q

Who is required to report child abuse?

A

ANYONE who suspects it!

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16
Q

Why is Abuse Under reported?

A
  • Victim - Inability to express, Fear of retaliation, lack of trust in provider, failure to recognize that abuse is abnormal
  • Provider - Failure to suspect/detect abuse, broach subject with parents, putting child in “the system”, equate child neglect with abuse
  • Parent - Fear of retaliation by abuser, Concern over being “punished” or losing child, Inability to recognize that abuse is occurring, Thinking situation is “under control” or will not recur
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17
Q

consequences of Failure to report child abuse?

A
  • a misdemeanor in 40 states.
  • if had a reasonable suspicionand didn’t report = prosecuted
  • charges can be upgraded to felonies
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18
Q

Profile of an Abuser?

A

ANYONE WHO HAS ACCESS TO A CHILD !!! - Parents, Teachers, Other family members, Coaches, and Family Friends

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19
Q

profile of abuser who is the parent?

A
  • May avoid other parents in neighborhood
  • May not participate in school activities
  • Might be uncomfortable talking about their children’s injuries or behavioral problems
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20
Q

profile of an adult who sexually abuses?

A
  • Usually know their victims and use the relationship to their advantage
  • Possibly were abused themselves as a child
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21
Q

T/F: all abuser have the intent to harm the child

A
  • F: NOT ALL ABUSERS ARE INTENTIONALLY HARMING THEIR CHILDREN
  • Many have been victims themselves and don’t know any other way to parent
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22
Q

parental RF for child abuse?

A
  • Young
  • Single
  • Low education or intellectually handicapped
  • Unstable family situation
  • Personal history of abuse, involved in domestic violence situations
  • Psychiatric illness
  • Substance abuse
  • Unskilled in parenting
  • Socially isolated
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23
Q

environmental RF for child abuse?

A
  • Family stress (financial, divorce, conflict)
  • Illness
  • Job loss or financial issues
  • Social isolation
  • Distant or absent extended family
  • Poverty
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24
Q

victim RF for child abuse?

A
  • < 3 years old
  • African American or Native American
  • Unplanned or unwanted
  • Speech or language disorders
  • ADHD
  • Intellectual disability
  • Handicapped or chronically ill
  • Adopted
  • Stepchildren
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25
Q

common hisorical features/red flags that are suspicious of child abuse?

A
  1. Implausible mechanism provided for an injury
  2. Discrepant, evolving or absent history
  3. Delay in seeking care
  4. Event or behavior by a child that triggers a loss of control by the caregiver
  5. History of abuse in the caregiver’s childhood
  6. Inappropriate affect on the caregiver
  7. Pattern of increasing severity or number of injuries if no intervention
  8. Social or physical isolation of the child or the caregiver
  9. Stress or crisis in the family or the caregiver
  10. Unrealistic expectations of the caregiver for the child
  11. Behavior changes of child
  12. Abuse of other children by child
  13. Unwitnessed injury
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26
Q

sx of child abuse?

A
  1. sad or angry
  2. relationship problems
  3. engaging in risky behavior or acting out
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27
Q
  • MC form of child abuse
  • > 75 - 80% of reported CPS cases
  • Girls > boys
A

neglect

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28
Q

neglect is Failing to provide for the child’s what 4 basic needs

A
  1. Food
  2. Clothing
  3. Supervision
  4. Hygiene
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29
Q

types of neglect/abandonment

A
  1. Physical: Failure to provide for the child’s necessities
  2. Emotional: Failure to provide love, security, emotional support, affection, psychological care
  3. Educational: Failure to enroll in school or ensure attendance; or to address specific educational needs
  4. Medical: Refusal to seek or any delay in seeking medical care resulting in damage or risk of damage to the child’s health
30
Q

s/s of neglect

A
  1. Failure to Thrive
  2. Decreased fat in cheeks, buttocks, limbs
  3. Nutritional deficiencies
  4. Vitamin deficiencies
  5. Developmental Delay
  6. Poor hygiene (clothes, body)
  7. Severe, untreated dental caries
  8. School truancies
  9. Inadequate supervision
31
Q

mgmt for neglect

A
  1. Hospitalization (failure to thrive)
  2. Report to CPS - at imminent harm from lack of supervision or protection; Continuing medical or dental neglect; Gross failure to provide adequate food, shelter, clothing or protection
  3. Educate parents
32
Q

Children returned to their families after an event of maltreatment have ?% chance of a second event.
The majority of both initial and recurrent events are neglect.

A

11-50%

33
Q
  • > 40% of child abuse deaths are pateints how old?
  • MCC?
A
  • < 1 year old
  • Abusive head trauma
34
Q

MC perpetrator of physical abuse?
MC to cause abusive head trauma?

A
  • Biological Parents - 81%
  • Fathers
35
Q

Physical Abuse vs. Discipline?

A
  1. Unpredictability
  2. Lashing out in anger
  3. Using fear to control behavior
36
Q

Most Common Physical Findings of physical abuse?

A
  • Bruises (may be patterned), burns, fractures, head trauma, abdominal injuries
  • Always suspect in cases of unexpected pediatric deaths
  • Major physical exam findings may be ABSENT
37
Q

bruising pattern of physical abuse

A
  1. Buttocks, back, trunk, genitalia, inner thighs, axilla, cheeks, earlobes and neck more suggestive of abuse
  2. Babies who are not mobile
  3. Multiple bruises in patterns or clusters
  4. Color of bruise is not accurate
  5. Sentinel Injuries: Rule of TEN-4
    - Trunk, Ear, Neck in any child < 4 mo
    - Any child < 4 mo with bruises to the trunk, ear or neck have a 97% sensitivity and 84% specificity indication of abuse
38
Q

MC fracture characteristic for physical abuse?

A
  • a single fracture
  • MC femur
39
Q

Bruises over bony prominences (elbow, shins) in toddlers and small children

is this normal?

A

ya

40
Q

bruising that is more concering for physical abuse?

A
  1. Non-mobile bruises in infants
  2. Soft tissue bruising
  3. Injury to frenulum / tonsils / lips (force feeding)
  4. Burns - stocking or glove pattern; immersion burns of buttocks; branding burns - Absence of splash marks or spillage pattern in scald burns
  5. Retinal hemorrhages in infant w/o associated condition (leukemia, congenital infection, clotting disorder) - Suspect abuse / head trauma
41
Q

MC XR finding that suggests physical abuse?

A

Diaphyseal - single, fresh fractures of the diaphysis (shaft) of long bones - spiral and transverse

42
Q

with Fractures in multiple stages of healing, what additional w/u do you need for children < 2 y/o?

A

Skeletal survey

43
Q

imaging used to evaluate abusive head trauma or abdominal trauma?

A

CT

44
Q

proper skeletal survery requires how many views?

A

21- -assess appendicular & axial skeleton

45
Q

labs for physical abuse?

A
  • CBC and Coags - Multiple bruises or severe bruises
  • ALT/AST/Lipase - Internal injuries
46
Q

mgmt for physical abuse?

A
  1. History obtained by ppl with specialized training - CPS, Social workers, Child abuse pediatricians
  2. Open ended questions about the injury if child able to communicate - red flag: Refusal to interview the child alone
  3. Document !!!
  4. Referrals - CPS, specialists (Endocrine, Ophthalmologists, etc.)
47
Q

T/F: Reported number believed to be grossly underestimated in reality of true prevalence for sexual abuse

A

T

  • Girls more likely to be abused
  • Boys less likely to report
48
Q

presentation of sexual abuse?

A
  • Majority have NO physical findings - Delayed disclosure, no physical trauma and rapid healing
  • Erythema, rashes, irritation of genital / rectal regions
  • Labial, hymenal and anal trauma - abrasions, lacerations and contusions
  • STDs - suggestive of abuse, esp beyond perinatal period
49
Q

what STDs are suggestive of abuse?

A
  • Gonorrhea / Syphilis - diagnostic of sexual abuse after the perinatal period
  • Chlamydia, Trichomonas, HIV - diagnostic if mother had prenatal care w/u; suspect if w/u completed and was negative
  • HSV, HPV - suspect
  • BV and molluscum - inconclusive
50
Q

mgmt for sexual abuse

A
  • Early (< 120 h with high suspicion) - ER; CPS
  • Late (> 120 h and low suspicion) - Sexual Abuse Clinic; CPS
51
Q

indications for sexual abuse Evaluation by a specialist at ED?

A
  1. Abuse occurred within 120 hours
  2. Genital or anal injuries that require treatment
  3. Forensic evidence needing collected on clothes or body
  4. Danger of continued abuse
  5. Victim is homicidal or suicidal
  6. Sexual Assault Nurse Evaluator (SANE) system for evidence collection
52
Q

indications for sexual abuse Evaluation by a specialist at Sexual abuse clinic?

A
  1. Vague complaints
  2. Abuse outside immediate time window
  3. No physical signs
  4. No immediate danger
53
Q

positions to evaluate for sexual abuse?

A
  • frog leg position - female: Labia majora, minora, introitus, and hymen
  • standing and in frog leg position - male: Penis, scrotum, perineal area, and anus
  • prone knee-chest position: Helpful in evaluating anogenital area, posterior hymen and vagina
54
Q

what is SANE?

A

sexual assault forensic evidence
- collection of evidence if: there is reasonable concern that sexual abuse has occurred, child has a genital injury as the result of alleged sexual abuse, clothing or linen associated with the abuse is available, other concerning clinical features

55
Q

labs for sexual abuse/assault

A
  1. < 120 hours - rape kit (rarely indicated in prepubertal child)
  2. > 120 hours -gonorrhea, chlamydia, evaluate for trichomonas - test all involved orifices for these
  3. Serum testing for RPR, Hep B, HIV at baseline and 3 m, 6 m, and 12 m
  4. Pregnancy screen?
56
Q

mgmt for sexual abuse

A
  1. STI prophylaxis - Ceftriaxone; Metronidazole; Azithromycin
  2. Hep B prophylaxis with immunoglobulin if high risk
  3. HIV prophylaxis if high risk
  4. Pregnancy prevention if < 120 hours
57
Q

Some might say this is the most common form of abuse as it is inherently a part of all other types of child abuse and neglect.

A

Emotional Abuse

58
Q

types of Emotional Abuse

A
  1. neglect
  2. rejecting/belitting
  3. isolating
  4. terrorizing
  5. ignoring
  6. corrupting
  7. verbal assault/threatening
  8. overpressuring / criticising
59
Q

presentation of emotional abuse in child?

A
  • Loss of self esteem or confidence
  • Sleep difficulties
  • Somatic symptoms
  • Avoidant or phobic behaviors
60
Q

Sequela of child abuse / neglect

A
  • immediate physical injuries, emotional and psychological problems
  • future violence victimization and perpetration, substance abuse, STIs, delayed brain development, lower educational attainment, and limited employment opportunities
  • toxic stress = change brain development and increase risk for problems like PTSD and learning, attention, and memory difficulties
61
Q

mgmt for emotional abuse?

A
  1. Parent Education
  2. CPS referral if extreme
  3. Other specialty referrals:
    - Psychology - family counseling, parenting
    - Psychiatry - dealing with concerns of depression and anxiety
62
Q

Certain characteristics are common in a person with MSP, including:

A
  1. MC a mother;May be a health care professional
  2. very friendly and cooperative with the health care providers
  3. overly concerned about child
  4. child has h/o many hospitalizations, often with a strange set of sx.
  5. Worsening of child’s sx reported by parent and not witnessed by staff
  6. reported condition and sx do not agree with results of tests.
  7. > 1 unusual illness or death of children in the family.
  8. condition improves in hospital, but sx recur when the child returns home.
  9. Blood in lab samples may not match the blood of child.
  10. There may be signs of chemicals in the child’s blood, stool, or urine.
63
Q

presentation of medical abuse/MBP

A
  • Bizarre, recurrent complaints
  • Doctor shopping
  • May appear ill - More often reportedly ill with normal appearance
  • Recurrent apnea
  • Dehydration (induced vomiting / diarrhea)
  • Sepsis (contaminants injected into child)
  • Altered mental status
  • GI bleeding
  • Fever
  • Seizures
64
Q

MC perpetrator of MBP

A

mom

65
Q

prevention of physical abuse?

A
  1. Public health nurse home visits to at-risk families
  2. Parent education and guidance on stressful situations - colic, crying, toilet training
  3. Parent education and guidance on age-appropriate development and discipline
  4. Education on safe childcare and partner choices to parents
66
Q

prevention of sexual abuse?

A
  1. Teaching children to protect themselves
  2. Encourage parents to have open discussions with children
  3. Internet safety education
  4. Limit exposure to sexualized materials and media
67
Q

prevention of emotional abuse?

A
  1. Promote positive, nurturing and nonviolent behaviors in parents
  2. Parent education and guidance on stressful situations, and age-appropriate development and discipline
  3. Encouraging parents to be role models
  4. Address psychiatric issues in child and parent
68
Q

prevention of neglect?

A
  1. Promote positive, nurturing and nonviolent behaviors in parents
  2. Parent education and guidance on stressful situations, and age-appropriate developmental and discipline
  3. Social services consult
  4. Nutritional education
  5. Address psychiatric issues in child and parent
69
Q

What to Do if You Suspect Abuse?

A

Contact someone IMMEDIATELY
Police
Child Protective Services (CPS)
Hospital Personnel

70
Q

common patterns/findings of physical abuse?

A
  1. handprint
  2. bruise of temple
  3. cord marks
  4. ligature marks
  5. anything on the ear

Pediatrics (23 decks)

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