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Pediatric EOR exam > Child abuse and neglect > Flashcards

Child abuse and neglect Flashcards

1
Q

what is the minimum definition of abuse and neglect

A

any act or failure to act
* resulting in death, serious harm, sexual abuse, or exploitation
* involving a child under 18
* by parent or caregiver responsible for the child’s welfare

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2
Q

what are the 4 types of abuse

A
  • neglect and abandonment
  • physical
  • sexual
  • emotional and psychological
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3
Q

what is considered sexual contact

A

any intentional touching of any part of another’s body by the actors sexual organs where the victim is not married to the actor and the touching is for the purpose of gratifying the sexual desire of either party

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4
Q

what is the definition of sexual intercourse

A

penetration of the female sex organ by the male sex organ or contact between sex organs of one and the mouth or anus of another

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5
Q

what is the definition of sexual intrusion

A

penetration of the female sex organ or anus of any person by an object for the purpose of degrading or humiliating the person penetrated

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6
Q

what is the definition of substance abuse

A
  • allowing a child to drink alcohol or illegal drugs
  • making, ingesting, or distributing drugs in the presence of a child
  • exposing a fetus to illegal drugs or other substances while pregnant
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7
Q

what is the definition of medical abuse

A

lack of proper medical care or inappropriate care

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8
Q

what is Munchausen syndrome by proxy

A

adult caretaker makes a child appear mentally or physically ill or impaired by either fabricating the symptoms or actually causing harm to the child

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9
Q

what is the MC type of abuse

A

Neglect

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10
Q

Whois required to report child abuse

A

anyone who suspects it

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11
Q

why is abuse underreported by the victim

A
  • inability to express
  • fear of retaliation
  • lack of trust in provider
  • failure to recognize
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12
Q

why is abuse underreported by the provider?

A
  • failure to suspect or detect
  • fear of broaching subject with parents
  • fear of putting child in the system
  • failure to equate neglect with abuse
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13
Q

why is abuse underreported by the parent?

A
  • fear of retaliation by abuser
  • concern over being punished or losing child
  • inability to recognize abuse is occurring
  • thinking situation is under control or will not recur
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14
Q

what are the parental risk factors of child abuse

A
  • young
  • single
  • low educations
  • psych illness
  • substance abuse
  • unskilled
  • personal history
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15
Q

environmental risk factors of child abuse

A
  • family stress
  • illness
  • job loss
  • social isolation
  • poverty
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16
Q

victim risk factors of child abuse

A
  • age
  • african american or native american
  • unplanned
  • intellectual disability
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17
Q

common historical factors in child abuse

A
  • delay in care
  • evolving history
  • implausible mechanism provided for an injury
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18
Q

what are the symptoms of abuse by the child

A
  • sad or angry
  • relationship troubles
  • engaging in risky behavior or acting out
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19
Q

what is the MC age for neglect

A

birth-3

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20
Q

what is the definition of neglect

A

failing to provide for the child’s basic needs, including food, clothing, supervision, and hygiene

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21
Q

what are the different types of neglect

A
  • physical: failure to provide for the child’s necessities
  • emotional: failure to provide love, security, emotional support, affection
  • educational: failure to enroll in school or ensure attendance or to address specific educational needs
  • medical neglect: refusal to seek or any delay in seeking medical care resulting in damage or risk of damage to the child’s health
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22
Q

what are the results of neglect

A
  • FTT
  • developmental delay
  • poor hygiene
  • nutritional deficiencies
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23
Q

what is the management of neglect

A
  • hospitalization
  • report to CPS
  • educate parents
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24
Q

what is the MC perpetrator of physical abuse

A

biological parents

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25
Q

what is the MC person to perform abusive head trauma

A

fathers

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26
Q

what is the definition of physical abuse

A

injury inflicted by a caregiver via non-accidental means, regardless of intent or severity

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27
Q

true or false: physical punishment that results in excessive damage to the child is physical abuse

A

true

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28
Q

what are the signs of physical abuse

A
  • visible injuries
  • injuries at different stages of healing
  • explanations of injuries that done make sense
29
Q

what are the MC physical findings of physical abuse

A

bruises

30
Q

true/false: signs of physical abuse rarely mimic other diseases

A

False

31
Q

what are the bruising patterns of physical abuse

A
  • butt, back, trunk, genitalia, axilla, cheeks, neck
  • multiple bruises in patterns or clusters
32
Q

what are sentinel injuries

A
  • trunk, ear, neck in any child less than 4 months old
33
Q

what is the MC bone to be fractured in abuse

A

Femur

34
Q

what are normal vs concerning bruises in children

A
  • normal: over bony prominences in toddlers and small children
  • concerning: soft tissue bruising, non-mobile bruises,
35
Q

what are xray findings of child abuse

A
  • diaphyseal spiral or transverse fractures
  • rib fractures
  • skull fractures
  • metaphyseal corner fractures in infants
36
Q

what are the CT findings of child abuse

A

subdural hemorrhage in infant without clear accidental history

37
Q

what is the management of physical abuse

A
  • document
  • referrals for injuries
38
Q

what is the difference in sexual assault in boys vs. girls

A
  • girls: more likely to be abused
  • boys: less likely to report
39
Q

what are the typical sexual abuse perpetrators

A

males that are trusted by the family

40
Q

what is the definition of sexual abuse

A

exposing a child to sexual situations or material is abusive, whether or not touching is involved

41
Q

true/false: making a child watch porn is sexual abuse

A

true

42
Q

what are signs of sexual abuse

A
  • doesn’t want to change clothes
  • withdrawn, depressed
  • eating disorder
  • OCD
  • decline in school performance
43
Q

what is seen on a PE of sexual abuse

A
  • many have none
  • genital/rectal irritation or trauma
  • STDs
44
Q

STDs diagnostic of sexual abuse after perinatal period

A
  • gonorrhea
  • syphillis
45
Q

What STDs are considered diagnostic of sexual abuse if the mother had proper prenatal care

A
  • chlamydia
  • trich
  • HIV
46
Q

STDs to suspect sexual abuse

A
  • HSV
  • HPV
47
Q

how do you manage sexual abuse

A
  • early (less than 120 hours with high suspicion): emergency room and CPS referral
  • late (more than 120 hours): sexual abuse clinic and CPS referral
48
Q

what are indications for emergency room evaluation for SA

A
  • within 120 hours
  • injuries that require treatment
  • forensic evidence needed collecting
  • danger of continued abuse
49
Q

indications for sexual abuse clinic evaluation for SA

A
  • vague complaints
  • abuse outside immediate time window
  • no physical signs
  • no immediate danger
50
Q

How would PE of sexual abuse need to be performed

A
  • visualization of male and female in frog leg position
  • visualization of child in prone knee-chest position
51
Q

when is speculum exam needed for SA?

A

active bleeding (perform with sedation)

52
Q

What is SANE

A

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

53
Q

what are the lab studies that are done with sexual assault

A
  • in within 120 hours: rape kit
  • if over 120 hours: STD testing
54
Q

what is the treatment of sexual assault

A
  • prophylactic treatment of gonorrhea, chlamydia, trichomonas, Hep B, and HIV
  • pregnancy prevention if <120 hours
55
Q

what is the definition of rejecting a child

A

refusing to acknowledge a child’s worth, legitimacy of needs, shaming, child is “no good”, “bad”, “mistake”

56
Q

what is the definition of isolating a child

A

denying normal social experiences and relationships; making a child feel “alone”; locking a child in a room

57
Q

what is the definition of terrorizing a child

A

verbal assault/threatening of his/her loved ones or objects; making child feel unsafe

58
Q

what is the definition of ignoring corrupting behavior in a child

A

stimulating and reinforcing destructive, antisocial, deviant or sexually exploitable behavior

59
Q

what is the definition of verbal assault/threatening a child

A

name calling, sarcasm damaging self esteem; singling out punishment; humiliating in public

60
Q

what is the definition of overpressuring/criticizing a child

A

comparing to others, criticising age-appropriate behavior as inadequate

61
Q

what are the s/s of emotional abuse

A
  • loss of self esteem
  • sleep difficulties
  • somatic symptoms
  • avoidant behaviors
62
Q

how do you manage emotional abuse

A
  • parent education
  • CPS referral if extreme
  • psych referral
63
Q

who is the MC perpetrator for munchausen by proxy

A

Mother

64
Q

How do you prevent physical abuse

A
  • public health nurse home visits
  • parent education
65
Q

what is the prevention of sexual abuse

A
  • teach children to protect themselves
  • encourage parents to have open conversations with children
  • internet safety
66
Q

how do you prevent emotional abuse

A
  • promote positive behaviors in parents
  • parent education
  • encourage parents to be role models
  • address psych issues in child and parent
67
Q

How do you prevent neglect

A
  • promote positive behaviors in parents
  • parent education
  • nutrition education
  • social services consult
68
Q

what do you do if you suspect abuse

A

contact police, CPS, or hospital personnel immediately

Pediatric EOR exam (20 decks)

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