Child Abuse and Neglect - Exam 3 Flashcards
CAPTA defines child abuse as any recent act OR FAILURE to act that results in what 3 things?
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
What does the child abuse prevention act of 1974 provide? (CAPTA)
federal funding to states in support of prevention, investigation, prosecution and information in the prevention of child abuse
What are the 4 major categories of abuse?
Neglect and Abandonment
Physical Abuse
Sexual Abuse
Emotional or Psychological Abuse
What does the term “neglect” encompass?
Neglect - when not due primarily to lack of financial means
Neglect - both actual and potential harm
_____ 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.
physical abuse
_____ 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
sexual abuse
_______ refers to behaviors that harm a child’s self-worth or emotional well-being. Examples include name-calling, shaming, rejecting, withholding love, and threatening.
emotional abuse
______ 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.
neglect
What does sexual contact entail? What body parts?
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
______ 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
sexual intercourse
______ 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
sexual intrusion
What is considered substance abuse?
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
_____ is lack of proper medical care or inappropriate care
Medical Abuse
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?
1 in 7
Rates of child abuse and neglect are 5 times higher for children in families with low socioeconomic status.
Who is required to report child abuse?
ANYONE who suspects it!
In the state of WV, who are mandatory reporters of child abuse and neglect?
Why are child abuse VICTIMS not reporting it?
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
Why do PROVIDER fails to report child abuse?
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
Why do PARENTS fail to report child abuse?
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
Failure to report suspected child abuse is a _____ in 40 states. Can they prosecute you?
misdemeanor
if they have reasonable suspicion that you did not report, you can be prosecuted
What is the profile of an abuser? What is the profile of an sexual abuser?
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
T/F: All abusers who harm their children are doing it intentionally
false!!
NOT ALL ABUSERS ARE INTENTIONALLY HARMING THEIR CHILDREN
Many have been victims themselves and don’t know any other way to parent
What are the child abuse risk factors?
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
What are the environmental risk factors for child abuse?
Family stress (financial, divorce, conflict)
Illness
Job loss or financial issues
Social isolation
Distant or absent extended family
Poverty
What are victim risk factors for child abuse?
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
**What are the highlight common historical features of child abuse?
Delay in seeking medical care
unwitnessed injury
blaming abuse of child on their siblings
_____ is the MC form of child abuse. Encompasses more than ____ of all reported CPS cases. What is the highest age range? Girls or boys?
neglect
more than 75 - 80%
Highest rate between the age of birth - 3
girls
What is considered neglect?
Failing to provide for the child’s basic needs
food, clothing, supervision, hygiene
What are 3 examples of physical neglect?
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
**What is the MC form of neglect? What is 2nd MC?
Inadequate supervision
failure to thrive
How should you manage a cause of child neglect?
Hospitalization (failure to thrive)
Report to CPS!!!
educate the parents
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 _____.
11 to 50%
neglect
Prevalence at any time during childhood is about _____. _____ of child abuse deaths are in patients _____. What is the cause of death?
20%
> 40% LESS than 1 year old
Abusive head trauma
While rates of physical abuse have _____ fatalities have _____
Rates of abuse have declined
fatalities have NOT declined
4.5 deaths/day
_____ are the MC perpetrators of physical abuse. _____ are most common to cause abusive head trauma
biological parents
fathers- head trauma
______ Injury inflicted by a caregiver via non-accidental means, regardless of intent or severity
physical abuse
What are the major differences between physical abuse and discipline?
physical abuse is unpredictable, usually done as a form of lashing out in anger and using fear to control behavior
What are some physical signs of child abuse?
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
_____ is the MC PE finding of child abuse. Are there usually any other major PE findings?
bruising is MC
other major PE findings are absent
What are places that you need to check for bruising if you suspect child abuse?
Buttocks, back, trunk, genitalia, inner thighs, axilla, cheeks, earlobes and neck more suggestive of abuse
What is the sentinel injury rules of TEN-4?
Trunk, Ear, Neck in any child less than 4 years old (or infants less than 4 months) = suggestive of abuse
_____ is the 2nd MC injury seen in physical abuse. Which one specifically?
fractures
if single fx= femur
rib fx= 71% indicative of abuse
What does injury to frenulum / tonsils / lips suggest? Retinal hemorrhages in infant?
forced feeding
suspect abuse via shaking or head trauma
What is the MC fracture pattern in child abuse?
Diaphyseal - single, fresh fractures of the diaphysis (shaft) of long bones most common fracture pattern in child abuse - spiral and transverse
What should you do in a kiddo who has multiple fractures in multiple different stages of healing?
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
What am I? What is the likely cause?
metaphyseal corner fracture
usually seen in infants from jerking arm or leg
What am I?
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
What lab studies should you order in a kiddo that you suspect of child abuse?
CBC and Coagulation studies-> Multiple bruises or severe bruises
ALT/AST/Lipase -> Internal injuries
Who needs to get the hx from the kiddo if you suspect child abuse? What is a red flag?
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
What is the age range for sexual abuse? Who is the likely perpetrator?
Primarily in preadolescent years: Girls more likely to be abused, Boys less likely to report
Perpetrators typically males and trusted by family
T/F: Exposing a child to sexual situations or material is abusive, whether or not touching is involved
TRUE!! produces layers of guilt and shame
Will the kiddo usually have any PE findings of sexual abuse? ______ is super suggestive of sexual abuse
Majority have NO physical findings
STDs beyond the perinatal period
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?
need to go to ER!!, immediate CPS referral
late: sexual abuse clinic and CPS referral
What is the management in the ED of a sexual abuse survivor?
What pt parameters would make you more inclined to send them to a sexual abuse clinic vs the ED?
sexual abuse clinic:
Vague complaints
Abuse outside immediate time window
No physical signs
No immediate danger
When is a sexual assault forensic evidence kit used?
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
For sexual assault cases if within ____ hours will need ______
last 120 hours
rape kit is needed
If greater than ____ hours, should evaluate sexual assault survivor for ______. What is the follow up? What is the tx?
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
What is the prevalence of isolated emotional abuse? What is considered emotional abuse?
around 10%
Anything creating a negative effect on a child’s emotional development or self-worth
What are ways to prevent physical child abuse?
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
What do you do if you suspect child abuse?
contact someone immediately!!
police,
CPS
hospital personnel
What part of the body, if bruised in a kiddo is suspect for child abuse?
EAR
anything on the ear is suspect for child abuse
