Child Abuse and Neglect - Exam 3

Question 1

CAPTA defines child abuse as any recent act OR FAILURE to act that results in what 3 things?

Answer 1

Resulting in death, serious physical or emotional harm, sexual abuse, or exploitation; or imminent risk of serious harm

Involving a child (under age 18, unless state law specifies a younger age for non-sexual-abuse cases)

By parent or caretaker (including any employee of a residential facility or staff providing out-of-home care) who is responsible for the child’s welfare

Question 1

What does the child abuse prevention act of 1974 provide? (CAPTA)

Answer 1

federal funding to states in support of prevention, investigation, prosecution and information in the prevention of child abuse

Question 2

What are the 4 major categories of abuse?

Answer 2

Neglect and Abandonment

Physical Abuse

Sexual Abuse

Emotional or Psychological Abuse

Question 3

What does the term “neglect” encompass?

Answer 3

Neglect - when not due primarily to lack of financial means

Neglect - both actual and potential harm

Question 4

_____ is the 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.

Answer 4

physical abuse

Question 5

_____ 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

Answer 5

sexual abuse

Question 6

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

Answer 6

emotional abuse

Question 7

______ is the 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.

Answer 7

neglect

Question 8

What does sexual contact entail? What body parts?

Answer 8

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

Question 9

______ 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

Answer 9

sexual intercourse

Question 10

______ 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

Answer 10

sexual intrusion

Question 11

What is considered substance abuse?

Answer 11

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

Question 12

_____ is lack of proper medical care or inappropriate care

Answer 12

Medical Abuse

Question 13

At least _____ children have experienced child abuse or neglect in the past year in the United States. How does this compare to kiddos living in poverty?

Answer 13

1 in 7

Rates of child abuse and neglect are 5 times higher for children in families with low socioeconomic status.

Question 14

Who is required to report child abuse?

Answer 14

ANYONE who suspects it!

Question 15

In the state of WV, who are mandatory reporters of child abuse and neglect?

Answer 15

Question 16

Why are child abuse VICTIMS not reporting it?

Answer 16

inability to express what is going on either because they are a very young child or intellectual impairment

fear of retaliation

lack of trust in provider

failure to recognize that abuse is abnormal

Question 17

Why do PROVIDER fails to report child abuse?

Answer 17

Failure to suspect/detect abuse

Fear of broaching subject with parents

Fear of putting child in “the system”

Failure to equate child neglect with abuse

Question 18

Why do PARENTS fail to report child abuse?

Answer 18

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

aka the male parents is also abusing the female parent and female parents does not report child abuse

Question 19

Failure to report suspected child abuse is a _____ in 40 states. Can they prosecute you?

Answer 19

misdemeanor

if they have reasonable suspicion that you did not report, you can be prosecuted

Question 20

What is the profile of an abuser? What is the profile of an sexual abuser?

Answer 20

anyone who has access to the child!!!

Sexual abuse: usually know their victims and use the relationship to their advantage
Possibly were abused themselves as a child

Question 21

T/F: All abusers who harm their children are doing it intentionally

Answer 21

false!!

NOT ALL ABUSERS ARE INTENTIONALLY HARMING THEIR CHILDREN

Many have been victims themselves and don’t know any other way to parent

Question 22

What are the child abuse risk factors?

Answer 22

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

Question 23

What are the environmental risk factors for child abuse?

Answer 23

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

Question 24

What are victim risk factors for child abuse?

Answer 24

Age (patients < 3 years old) African American or Native American Unplanned or unwanted Speech or language disorders ADHD Intellectual disability Handicapped or chronically ill Adopted Stepchildren

Question 25

**What are the highlight common historical features of child abuse?

Answer 25

Delay in seeking medical care unwitnessed injury blaming abuse of child on their siblings

Question 26

_____ is the MC form of child abuse. Encompasses more than ____ of all reported CPS cases. What is the highest age range? Girls or boys?

Answer 26

neglect more than 75 - 80% Highest rate between the age of birth - 3 girls

Question 27

What is considered neglect?

Answer 27

Failing to provide for the child's basic needs food, clothing, supervision, hygiene

Question 28

What are 3 examples of physical neglect?

Answer 28

Adequate food, shelter, clothing, protection, hygiene, supervision, education Locking a child in a closet or room, placing in a dangerous situation that could lead to physical injury or death Left alone for extended periods of time or suffers serious harm because no one looking after them

Question 29

**What is the MC form of neglect? What is 2nd MC?

Answer 29

Inadequate supervision failure to thrive

Question 30

How should you manage a cause of child neglect?

Answer 30

Hospitalization (failure to thrive) Report to CPS!!! educate the parents

Question 31

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

Answer 31

11 to 50% neglect

Question 32

Prevalence at any time during childhood is about _____. _____ of child abuse deaths are in patients _____. What is the cause of death?

Answer 32

20% > 40% LESS than 1 year old Abusive head trauma

Question 33

While rates of physical abuse have _____ fatalities have _____

Answer 33

Rates of abuse have declined fatalities have NOT declined 4.5 deaths/day

Question 34

_____ are the MC perpetrators of physical abuse. _____ are most common to cause abusive head trauma

Answer 34

biological parents fathers- head trauma

Question 35

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

Answer 35

physical abuse

Question 36

What are the major differences between physical abuse and discipline?

Answer 36

physical abuse is unpredictable, usually done as a form of lashing out in anger and using fear to control behavior

Question 37

What are some physical signs of child abuse?

Answer 37

Injury to child who is not yet mobile Injuries at different stages of healing and different body surfaces Explanation of injuries that don’t make sense Child wears long sleeves, pants out of season

Question 38

_____ is the MC PE finding of child abuse. Are there usually any other major PE findings?

Answer 38

bruising is MC other major PE findings are absent

Question 39

What are places that you need to check for bruising if you suspect child abuse?

Answer 39

Buttocks, back, trunk, genitalia, inner thighs, axilla, cheeks, earlobes and neck more suggestive of abuse

Question 40

What is the sentinel injury rules of TEN-4?

Answer 40

Trunk, Ear, Neck in any child less than 4 years old (or infants less than 4 months) = suggestive of abuse

Question 41

_____ is the 2nd MC injury seen in physical abuse. Which one specifically?

Answer 41

fractures if single fx= femur rib fx= 71% indicative of abuse

Question 42

What does injury to frenulum / tonsils / lips suggest? Retinal hemorrhages in infant?

Answer 42

forced feeding suspect abuse via shaking or head trauma

Question 43

What is the MC fracture pattern in child abuse?

Answer 43

Diaphyseal - single, fresh fractures of the diaphysis (shaft) of long bones most common fracture pattern in child abuse - spiral and transverse

Question 44

What should you do in a kiddo who has multiple fractures in multiple different stages of healing?

Answer 44

Skeletal survey in children 2 years of age and younger with a suspicious fracture Method of choice for global skeletal imaging in suspected abuse per AAP

Question 45

What am I? What is the likely cause?

Answer 45

metaphyseal corner fracture usually seen in infants from jerking arm or leg

Question 46

What am I?

Answer 46

a type of fracture in the metaphysis (the growing part of a long bone) that is strongly associated with non-accidental trauma, particularly child abuse

Question 47

What lab studies should you order in a kiddo that you suspect of child abuse?

Answer 47

CBC and Coagulation studies-> Multiple bruises or severe bruises ALT/AST/Lipase -> Internal injuries

Question 48

Who needs to get the hx from the kiddo if you suspect child abuse? What is a red flag?

Answer 48

History should be obtained by individuals with specialized training-> CPS, Social workers, Child abuse pediatricians Refusal to interview the child alone is a red flag

Question 49

What is the age range for sexual abuse? Who is the likely perpetrator?

Answer 49

Primarily in preadolescent years: Girls more likely to be abused, Boys less likely to report Perpetrators typically males and trusted by family

Question 50

T/F: Exposing a child to sexual situations or material is abusive, whether or not touching is involved

Answer 50

TRUE!! produces layers of guilt and shame

Question 51

Will the kiddo usually have any PE findings of sexual abuse? ______ is super suggestive of sexual abuse

Answer 51

Majority have NO physical findings STDs beyond the perinatal period

Question 52

What is the management of a survivor of sexual abuse if the abuse occurred less than 120 hours ago with high suspicion? more than 120 hours ago and low suspicion?

Answer 52

need to go to ER!!, immediate CPS referral late: sexual abuse clinic and CPS referral

Question 53

What is the management in the ED of a sexual abuse survivor?

Answer 53

Question 54

What pt parameters would make you more inclined to send them to a sexual abuse clinic vs the ED?

Answer 54

sexual abuse clinic: Vague complaints Abuse outside immediate time window No physical signs No immediate danger

Question 55

When is a sexual assault forensic evidence kit used?

Answer 55

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

Question 56

For sexual assault cases if within ____ hours will need ______

Answer 56

last 120 hours rape kit is needed

Question 57

If greater than ____ hours, should evaluate sexual assault survivor for ______. What is the follow up? What is the tx?

Answer 57

greater than 120 hours culture for STDs Serum testing for RPR, Hepatitis B, HIV at baseline and 3 months, 6 months, and 12 months tx with: ceftriaxone, metro and azithro emergency pregnancy measures if applicable

Question 58

What is the prevalence of isolated emotional abuse? What is considered emotional abuse?

Answer 58

around 10% Anything creating a negative effect on a child’s emotional development or self-worth

Question 59

What are ways to prevent physical child abuse?

Answer 59

Public health nurse home visits to at-risk families Parent education and guidance on stressful situations Parent education and guidance on age-appropriate development and discipline Education on safe childcare and partner choices to parents

Question 60

What do you do if you suspect child abuse?

Answer 60

contact someone immediately!! police, CPS hospital personnel

Question 61

What part of the body, if bruised in a kiddo is suspect for child abuse?

Answer 61

EAR anything on the ear is suspect for child abuse