Child Abuse and Neglect

Question 1

Child abuse is broadly defined as what?

Answer 1

serious injury inflicted upon a child by a parent or caretaker

Question 2

Major Types of Child Abuse

4

Answer 2

1. Physical abuse
2. Sexual abuse
3. Emotional abuse
4. Child neglect

Question 3

Perpetrators for Child abuse?

3

Answer 3

1. Biological parents—81%
2. Nonbiological parents and parent partners—12%
3. Other adult—7%

Question 4

Risk factors?

4

Answer 4

1. Young or single parents
2. Those w/ lower levels of education
3. Many abusers were abused themselves as children
4. Many suffer from drugs/alcohol addiction and/or psychiatric illness

Question 5

Environmental factors?

4

Answer 5

1. Stress factors within the family– either acute or chronic
2. Social isolation
3. Distant or absent extended family
4. Acceptability of violence as a means of problem solving

Question 6

Certain children are more likely to be victims then others:

5

Answer 6

1. Age (67% less than 1YO) (80% less than 3YO)
2. Past h/o abuse: abused child 50% chance of experiencing further abuse and 10% chance of dying
3. Children w/ speech/language disorders, learning disabilities, non-conduct psych problems
4. Children w/ handicaps, chronic illness
5. Hyperactive, adopted and step-children

Question 7

What is the most prevelent form of child abuse?

Answer 7

Most prevalent form of child abuse (> ½ cases)

“failure to provide for a child’s basic physical, emotional, educational, or medical needs”

Question 8

What are the types of child neglect?

4

Answer 8

1. Physical neglect
2. Emotional neglect
3. Educational neglect
4. Medical neglect

Question 9

In cases of medical neglect, what could we do?

3

Answer 9

1. Simplify care as much as possible
2. Give written instructions
3. Remove barriers to access

Question 10

When should we hospitalize in cases of medical neglect?

3

Answer 10

1. For serious medical conditions
2. To protect the child
3. To observe parent-child interaction

Question 11

Clinical Manifestations:
Orofacial injuries (face is the area most commonly injured)?
7

Answer 11

1. Intraoral injuries
2. Burns
3. Fractures of the maxilla, mandible or facial bones
4. Oropharyngeal gonorrhea or syphilis
5. Black eyes or basilar skull fracture
6. Bruising or scarring corners of the mouth from being gagged
7. Traumatic alopecia

Question 12

What is the most common type of injury in abused children?

Answer 12

Bruises

Question 13

Describe the common types of bruising with child abuse?

5

Answer 13

1. Noninflicted bruising tends to be over bony prominences/central bruising suggests abuse***
2. Bruising in babies who are not mobile is uncommon
3. Multiple bruises in clusters are consistent w/ inflicted injury
4. Bruises in the pattern of an implement suggest inflicted injury (shape of handprint, belt, rope loop)
5. Ligature marks or rope burns are seen on the neck, wrists and ankles

Question 14

Differential Diagnosis of Bruises

3

Answer 14

1. Bleeding disorders:
2. Salicylate ingestion: look for other symptoms
   - –Henoch-Schonlein purpura/other vasculitides
3. Mongolian spots

Question 15

What would make us suspect bleeding disorder instead of child abuse? 2

Answer 15

1. Bruises uniform in color
   - - Inflicted bruises have different colors
2. Check clotting studies, CBC w/ platelets, PT,PTT

Question 16

What can bite marks on the child be associated with?

Answer 16

can be associated w/ physical or sexual abuse or both

Question 17

What kinds of burns are chacrteristic of child abuse?

5

Answer 17

1. Brands/contact burns
2. Cigarette burns
3. Immersion burns—usually seen on legs & buttocks
4. Microwave oven burns
5. Stun gun burns

Question 18

What fracture characteristics would point to child abuse? 2

If you see these findings what should you get?

Answer 18

1. Fracture doesn’t fit explanation
2. Fractures at multiple stages of healing

If you find this—get a skeletal survey

Question 19

Differential Diagnosis of Burns

3

Answer 19

1. Phytophotodermatitis
2. Complementary and alternative therapies
3. Congenital insensitivity to pain

Question 20

What kind of complementary and alternative therapies could cause burns?
4

Answer 20

1. Garlic applied to the skin
2. Cupping
3. Coining
4. Moxibustion

Question 21

Diagnostic Evaluation-History: Clues?

4

Answer 21

1. Historical inconsistencies
2. History is inconsistent w/ injury of the child***
3. History is vague or lacking in detail
4. No history: “His arm was just broken.”

Question 22

At what age should we talk to the child alone?

What would be a red flag in the interview process?

Answer 22

If the child is 3YO or older try to talk to the child alone

If parents won’t allow this—RED FLAG!

Question 23

Child should be asked open ended questions and then what?

4

Answer 23

“WH” questions:

Who, What, Where, When

Question 24

PE

8

Answer 24

1. Evaluation of general appearance including assessment of clothing

PE ideally performed with all the clothing removed and child in gown to assess for:

2. Skin lesions,
3. swelling,
4. deformity
5. Bone tenderness,
6. reluctance to use an extremity
7. Retinal hemorrhages
8. Trauma to the genitals or mouth

Question 25

Behavior of parents and interaction between family members should be observed concerning behaviors include: 6

Answer 25

1. Arguing, 2. roughness or violence 3. aloofness/lack of emotional interaction 4. Inappropriate response to the severity of the injury 5. Inappropriate delay in seeking medical care 6. A partial or frank confession by a parent

Question 26

Labs and Studes? | 7

Answer 26

1. Bleeding evaluation: 2. CMP: 3. UA 4. Toxicology 5. Skeletal survey: 6. Neuroimaging: to detect CNS injuries, r/o injury, evaluate for skull fractures 7. Ophthalmologic evaluation for retinal hemorrhages

Question 27

What would you do for a bleeding evaluation?

Answer 27

1. CBC w/ platelets, 2. PT, 3. PTT

Question 28

What would you want to look at in the CMP? 2 | And what would it rule out?

Answer 28

1. check LFT, 2. electrolytes, r/o bone disease

Question 29

What are we checking for in the UA?

Answer 29

—checking for hematuria

Question 30

What are we looking at in toxicology?

Answer 30

—inappropriate administration of medications

Question 31

Who should we do a skeletal survey on? | 2

Answer 31

1. any child less than 2YO w/ concerning fracture, intraabdominal or intrathoracic injury or concern for abusive head trauma; 2. also children 2-5 w/ impaired consciousness

Question 32

Definition of sexual assault?

Answer 32

Sexual assault: attempted sexual touching of another person without their consent & includes sexual intercourse (rape), sodomy (oral-genital or anal-genital contact), and fondling

Question 33

Definition for sexual assault in children?

Answer 33

For children: when a child engages in sexual activity for which he/she cannot give consent, is unprepared for developmentally, cannot comprehend, and/or an activity that violates the law or social taboos of society

Question 34

Sexual Abuse includes? | 5

Answer 34

1. Fondling 2. All forms of oral-genital, genital or anal contact w/ a child Non-touching abuses: 3. Exhibitionism 4. Voyeurism 5. Involving the child in pornography

Question 35

Describe sexual play? | 4

Answer 35

1. Occurs in the absence of coercion 2. Involves children of the same age (separated by no more than four years) 3. The children engage in viewing or touching each other’s genitalia because of mutual interest or curiosity 4. Considered normal behavior

Question 36

More specific presentations for sexual abuse? | 4

Answer 36

1. Rectal/genital bleeding 2. STIs 3. Pregnancy 4. Rectal/genital trauma

Question 37

Evaluation: Whenever possible, the evaluation should be performed by an experienced child abuse team, including a child abuse specialist. What are the goals? 4

Answer 37

1. Identify injuries or other conditions require treatment 2. Screen/diagnose STIs 3. Evaluate/and if possible, reduce the risk of pregnancy 4. To document findings and gather forensic evidence

Question 38

Adolescents & Sexual Abuse: What are the laws regarding confidentiality in sexual activity and abuse?

Answer 38

Can be reassured about confidentiality regarding their personal sexual activity BUT—health care providers are mandated to report disclosures about sexual abuse to child protective services

Question 39

Children who witness intimate partne violencer show an increase in? 6

Answer 39

1. Aggression and conduct disorders 2. Impulsivity 3. Anxiety and intrusive thoughts 4. Disrupted sleep patterns and depression 5. Posttraumatic stress disorder (PTSD) 6. May lead to risky behavior—drugs, sexual promiscuity, careless operation of vehicles

Question 40

Describe the RADAR acronym?

Answer 40

``` R—routinely screen patients for abuse A—ask direct questions D—document your findings A—assess safety of victim and children R—review options/referrals/reporting requirements ```

Question 41

Who do we perform radar on? | 4

Answer 41

* Perform on 1. new patients, 2. yearly, 3. when mother or teenager is involved in a new intimate relationship or 4. becomes pregnant

Question 42

What are the types of Child Neglect? | 4

Answer 42

Physical neglect Emotional neglect Educational neglect Medical neglect

Question 43

Emotional Abuse consists of? | 7

Answer 43

1. Rejecting 2. Isolating 3. Terrorizing 4. Ignoring 5. Corrupting 6. Verbal assault or spurning 7. Over pressuring

Question 44

Clinical features of emotionally abused child: 1. Emotional disturbances? 4 2. Social withdrawal? 4

Answer 44

1. Anxiety, 2. depression 3. Agitation, 4. fearfulness 1. Running away from home 2. Developmental delay 3. Drug or alcohol problems 4. Eating disorders