Child abuse and neglect Flashcards
1
Q
Definition of child abuse?
A
- serious injury inflicted upon a child by a parent or caretaker
- each state defines child abuse and neglect within its own civil and criminal codes
2
Q
Major types of child abuse?
A
- physical
- sexual
- emotional
- child neglect
3
Q
Main perps of child abuse?
A
- bilogicial parents: 81%
- nonbiological parents and parent partners: 12%
- other adult: 7%
4
Q
RFs of child abuse?
A
- young or single parents
- lower education
- many abusers were abused themselves as kids
- many suffer from drug/acohol addiction and psych illnesses
5
Q
How does environment have an affect on child abuse?
A
- stress factors within family: either acute or chronic
- social isolation
- distant or absent extended family
- acceptability of violence as a means of problem solving
6
Q
What children are more likely to be victims of child abuse?
A
- less than 1 (67%), less than 3 (80%)
- psat h/o of abuse: abused child 50% chance of experiencing further abuse and 10% of dying
- children with speech/learning disorders, learning disabilities, non-conduct psych probs
- children with handicaps, chronic illness
- hyperactive, adopted and step children
7
Q
What is child neglect? diff types?
A
- most prevalent form of child abuse (more than 1/2 of the cases)
- failure to provide for child’s basic physical, emotional, educational or medical needs
- types: physical, emotional, educational, and medical neglect
8
Q
Management of neglect?
A
- ID/recognize the problem
- discuss it with the family/interdisciplinary team
- cases of medical neglect: simplify care as much as possible, give written instructions, remove barriers to access
- hospitalization: for serious medical conditions, to protect the child, to observe parent-child interaction
9
Q
Mandated reporting?
A
- all 50 states have laws requiring health professionals to report child neglect/abuse to CPS
10
Q
Clinical manifestations of child abuse - orofacial injuries?
A
- face is area most commonly injured:
- intraoral injuries
- burns
- fractures of maxilla, mandible or facial bones
- oropharyngeal gonorrhea or syphilis
- black eyes or basilar skull fracture
- bruising or scarring corners of mouth from being gagged
- traumatic alopecia
11
Q
Clinical manifestations of child abuse: bruises?
A
- most common type of injury of abused kids
- noninflicted bruising tends to be over bony prominences and central bruising suggests abuse
- bruising in babies who are not mobile is uncommon
- mult bruises in clusters - consistent with inflicted injury
- bruises in pattern of an implement suggest inflicted injury (shape of handprint, belt, rope loop)
- ligature marks or rope burns seen on neck, wrists and ankles
12
Q
DDx of bruises?
A
bleeding disorders:
- bruises are uniform in color
- inflicted bruises have diff colors
- check clotting studies, CBC with platelets, PT, PTT
- salicylate ingestion: look for other sxs
- Henoch-Schonlein purpura/other vasculitides
- mongolian spots
13
Q
Other clinical manifestations that indicate abuse?
A
- bite marks: assoc with physical or sexual abuse
- burns: brands/contact burns
cigarette burns
immersion burns: legs and buttocks
microwave oven burns
stun gun burns - fractures:
fracture doesn’t fit explanation, fractures at mult stages of healing - get skeletal survey if this is found
14
Q
DDx of burns?
A
- phytophotodermatitis: sun can cause severe burns
- complementary and alt therapies: garlic applied to skin, cupping, coining, moxibustion
- congenital insensitivity to pain: can’t feel pain
15
Q
Clues to dx eval of child abuse?
A
- historical inconsistencies
- hx is inconsistent with injury of child
- hx is vague or lacking detail
- no hx
- parent isn’t upset about injury
- talk to parent and chil together, let child answer first
- if 3 or older - try to talk to kid alone, if parent doesn’t allow this- RED FLAG!!!
- ask child who, what, where, and when questions
16
Q
Physical exam of child?
A
- eval of general appearance - including assessment of clothing
- assess for skin lesions, swelling, deformity
- bone tenderness, reluctance to use an extremity, retinal hemorrhages, trauma to genitals or mouth
17
Q
What should you look for in parental behavior?
A
- arguing, roughness or violence
- aloofness/lack of emotional interactio
- inapprop response to seriousness of injury
- inapprop delay in seeking medical care
- a partial or frank confession by parent
18
Q
What labs/studies should be ordered in suspected child abuse?
A
- bleeding eval: CBC with platelets, PT, PTT
- CMP: LFT, electrolytes, r/o bone disease
- UA: hematuria
- toxicology: inapprop admin of meds
- skeletal survey: any child under 2 with concerning fracture, intrabdominal or intrathoracic injury or concern for abusive head trauma, also children 2-5 with impaired consciousness
- neuroimaging: to detect CNS injuries, r/o injury, eval for skull fractures
- ophtho: eval for retinal hemorrhages
19
Q
Definition of sexual assault? For kids?
A
- attempted sexual touching of another person without their consent and includes intercourse (rape), sodomy (oral-genital contact), and fondling
- in kids: when child engages in sexual activity for which he/she can’t give consent, is unprepared for developmentally, can’t comprehend, and/or an activity that violates the law or social taboos of society
20
Q
What does sexual abuse include?
A
- fondling
- all forms of oral-genital, genital or anal contact with a child
- non-touching abuses: exhibitionism, voyeurism, involving child in pornography
21
Q
What is sexual play?
A
- occurs in absence of coercion
- involves kids of same age (no more sep than 4 years)
- kids engage in viewing or touching each other
- considered normal
22
Q
Perps of sexual abuse are usually who?
A
- male and often trusted adult
23
Q
Presentation of sexual abuse?
A
- victims can present with variety of medical complaints
- more specific for sexual abuse:
rectal/genital bleeding
STIs
pregnancy
rectal/genital trauma
24
Q
Eval of suspected sexually assaulted child?
A
- if possible should be done by experienced child abuse team, including a child abuse specialist
goals:
- ID injuries or other conditions that reqr tx
- screen/dx STIs
- eval and if possible reduce risk of pregancy
- doc findings and gather forensic evidence
25
Q
Children who witness intimate parnter violence show an increase in?
A
- aggression and conduct disorders
- impulsivity
- anxiety and intrusive thoughts
- disrupted sleep patterns and depression
- PTSD
- may lead to risky behavior: drugs, sexual promiscuity, careless operation of vehicles
26
Q
RADAR? Perform on who?
A
- R: routinely screen pts for abuse
- A: ask direct ?s
- D: document findings
- A: assess safety of victim and children
- R: review options/referrals/reporting requirements
- perfomr on new pts, yearly, when mother or teen is involved in new intimate relationship or becomes pregnant
27
Q
Reporting abuse?
A
- if you suspect child abuse/neglect or intimate partner violence that is putting child at risk it is your duty to report and it is a law in all 50 states
- talk with parents that report is being filed
28
Q
What are the barriers to reporting child abuse?
A
- PCP thought alt strategies could be more effective than CPS
- inadequate training to recognize abuse
- cultural attitudes
- perception the CPS intervention in ineffective
29
Q
Forms of child neglect?
A
- physical
- emotional
- educational
- medical
30
Q
How do you approach neglect?
A
- discuss with caregivers the concerns
- team approach
- reportable
31
Q
What is considered emotional abuse?
A
- rejecting
- isolating
- terrorizing
- ignoring
- corrupting
- verbal assault or spurning
- over pressuring
32
Q
Clinical features of an emotionally abused child?
A
- emotional disturbances:
anxiety, depression, agitation, fearfulness - social withdrawal: running away from home, developmental delay, drug or alcohol problems, eating disorders
