Child Abuse and Neglect Flashcards
Child abuse is broadly defined as what?
serious injury inflicted upon a child by a parent or caretaker
Major Types of Child Abuse
4
- Physical abuse
- Sexual abuse
- Emotional abuse
- Child neglect
Perpetrators for Child abuse?
3
- Biological parents—81%
- Nonbiological parents and parent partners—12%
- Other adult—7%
Risk factors?
4
- Young or single parents
- Those w/ lower levels of education
- Many abusers were abused themselves as children
- Many suffer from drugs/alcohol addiction and/or psychiatric illness
Environmental factors?
4
- Stress factors within the family– either acute or chronic
- Social isolation
- Distant or absent extended family
- Acceptability of violence as a means of problem solving
Certain children are more likely to be victims then others:
5
- Age (67% less than 1YO) (80% less than 3YO)
- Past h/o abuse: abused child 50% chance of experiencing further abuse and 10% chance of dying
- Children w/ speech/language disorders, learning disabilities, non-conduct psych problems
- Children w/ handicaps, chronic illness
- Hyperactive, adopted and step-children
What is the most prevelent form of child abuse?
Most prevalent form of child abuse (> ½ cases)
“failure to provide for a child’s basic physical, emotional, educational, or medical needs”
What are the types of child neglect?
4
- Physical neglect
- Emotional neglect
- Educational neglect
- Medical neglect
In cases of medical neglect, what could we do?
3
- Simplify care as much as possible
- Give written instructions
- Remove barriers to access
When should we hospitalize in cases of medical neglect?
3
- For serious medical conditions
- To protect the child
- To observe parent-child interaction
Clinical Manifestations:
Orofacial injuries (face is the area most commonly injured)?
7
- Intraoral injuries
- Burns
- Fractures of the maxilla, mandible or facial bones
- Oropharyngeal gonorrhea or syphilis
- Black eyes or basilar skull fracture
- Bruising or scarring corners of the mouth from being gagged
- Traumatic alopecia
What is the most common type of injury in abused children?
Bruises
Describe the common types of bruising with child abuse?
5
- Noninflicted bruising tends to be over bony prominences/central bruising suggests abuse***
- Bruising in babies who are not mobile is uncommon
- Multiple bruises in clusters are consistent w/ inflicted injury
- Bruises in the pattern of an implement suggest inflicted injury (shape of handprint, belt, rope loop)
- Ligature marks or rope burns are seen on the neck, wrists and ankles
Differential Diagnosis of Bruises
3
- Bleeding disorders:
- Salicylate ingestion: look for other symptoms
- –Henoch-Schonlein purpura/other vasculitides - Mongolian spots
What would make us suspect bleeding disorder instead of child abuse? 2
- Bruises uniform in color
- - Inflicted bruises have different colors - Check clotting studies, CBC w/ platelets, PT,PTT
What can bite marks on the child be associated with?
can be associated w/ physical or sexual abuse or both
What kinds of burns are chacrteristic of child abuse?
5
- Brands/contact burns
- Cigarette burns
- Immersion burns—usually seen on legs & buttocks
- Microwave oven burns
- Stun gun burns
What fracture characteristics would point to child abuse? 2
If you see these findings what should you get?
- Fracture doesn’t fit explanation
- Fractures at multiple stages of healing
If you find this—get a skeletal survey
Differential Diagnosis of Burns
3
- Phytophotodermatitis
- Complementary and alternative therapies
- Congenital insensitivity to pain
What kind of complementary and alternative therapies could cause burns?
4
- Garlic applied to the skin
- Cupping
- Coining
- Moxibustion
Diagnostic Evaluation-History: Clues?
4
- Historical inconsistencies
- History is inconsistent w/ injury of the child***
- History is vague or lacking in detail
- No history: “His arm was just broken.”
At what age should we talk to the child alone?
What would be a red flag in the interview process?
If the child is 3YO or older try to talk to the child alone
If parents won’t allow this—RED FLAG!
Child should be asked open ended questions and then what?
4
“WH” questions:
Who, What, Where, When
PE
8
- Evaluation of general appearance including assessment of clothing
PE ideally performed with all the clothing removed and child in gown to assess for:
- Skin lesions,
- swelling,
- deformity
- Bone tenderness,
- reluctance to use an extremity
- Retinal hemorrhages
- Trauma to the genitals or mouth
Behavior of parents and interaction between family members should be observed concerning behaviors include:
6
- Arguing,
- roughness or violence
- aloofness/lack of emotional interaction
- Inappropriate response to the severity of the injury
- Inappropriate delay in seeking medical care
- A partial or frank confession by a parent
Labs and Studes?
7
- Bleeding evaluation:
- CMP:
- UA
- Toxicology
- Skeletal survey:
- Neuroimaging: to detect CNS injuries, r/o injury, evaluate for skull fractures
- Ophthalmologic evaluation for retinal hemorrhages
What would you do for a bleeding evaluation?
- CBC w/ platelets,
- PT,
- PTT
What would you want to look at in the CMP? 2
And what would it rule out?
- check LFT,
- electrolytes,
r/o bone disease
What are we checking for in the UA?
—checking for hematuria
What are we looking at in toxicology?
—inappropriate administration of medications
Who should we do a skeletal survey on?
2
- any child less than 2YO w/ concerning fracture, intraabdominal or intrathoracic injury or concern for abusive head trauma;
- also children 2-5 w/ impaired consciousness
Definition of sexual assault?
Sexual assault: attempted sexual touching of another person without their consent & includes sexual intercourse (rape), sodomy (oral-genital or anal-genital contact), and fondling
Definition for sexual assault in children?
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
Sexual Abuse includes?
5
- Fondling
- All forms of oral-genital, genital or anal contact w/ a child
Non-touching abuses:
- Exhibitionism
- Voyeurism
- Involving the child in pornography
Describe sexual play?
4
- Occurs in the absence of coercion
- Involves children of the same age (separated by no more than four years)
- The children engage in viewing or touching each other’s genitalia because of mutual interest or curiosity
- Considered normal behavior
More specific presentations for sexual abuse?
4
- Rectal/genital bleeding
- STIs
- Pregnancy
- Rectal/genital trauma
Evaluation: Whenever possible, the evaluation should be performed by an experienced child abuse team, including a child abuse specialist. What are the goals?
4
- Identify injuries or other conditions require treatment
- Screen/diagnose STIs
- Evaluate/and if possible, reduce the risk of pregnancy
- To document findings and gather forensic evidence
Adolescents & Sexual Abuse: What are the laws regarding confidentiality in sexual activity and abuse?
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
Children who witness intimate partne violencer show an increase in?
6
- Aggression and conduct disorders
- Impulsivity
- Anxiety and intrusive thoughts
- Disrupted sleep patterns and depression
- Posttraumatic stress disorder (PTSD)
- May lead to risky behavior—drugs, sexual promiscuity, careless operation of vehicles
Describe the RADAR acronym?
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
Who do we perform radar on?
4
- Perform on
1. new patients,
2. yearly,
3. when mother or teenager is involved in a new intimate relationship or
4. becomes pregnant
What are the types of Child Neglect?
4
Physical neglect
Emotional neglect
Educational neglect
Medical neglect
Emotional Abuse consists of?
7
- Rejecting
- Isolating
- Terrorizing
- Ignoring
- Corrupting
- Verbal assault or spurning
- Over pressuring
Clinical features of emotionally abused child:
- Emotional disturbances? 4
- Social withdrawal? 4
- Anxiety,
- depression
- Agitation,
- fearfulness
- Running away from home
- Developmental delay
- Drug or alcohol problems
- Eating disorders
