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Pediatrics Exam 4 > Child Abuse/Neglect > Flashcards

Child Abuse/Neglect Flashcards

1
Q

T/F neglect can be a single act

A

F - Rarely is neglect a single act
It is an accumulation of harm over time

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2
Q

What is neglect?

A
  • Rejection, ignoring, criticizing, isolation, or
    terrorizing of children → erode self-esteem
  • 6.5% of children every year are neglected
  • Most common form of maltreatment
    In 75% of abuse cases, neglect was confirmed
  • Most difficult to detect
    Clinicians must investigate psychosocial history,
    family dynamics, & parental mental health,
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3
Q

Physical neglect

A
  • Failure to provide the adequate necessities of food, shelter & clothing
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4
Q

Emotional neglect

A

Failure to provide necessary nurturing,
affection, stimulation
Most common form is verbal abuse or denigration

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5
Q

Educational neglect

A

Failure to provide an educational program; this, may include truancy

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6
Q

Medical/Dental neglect

A

Failure to provide basic medical & dental
care, which results or has the potential to result in harm; this
may include noncompliance with healthcare
recommendations

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7
Q

Supervisory neglect

A

Failure to supervise & ensure safety of a child, given the child’s developmental needs

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8
Q

Risk Factors for neglect: Children

A

Premature birth
Young age
Multiple gestation births
Ex. twin
Chronic disability

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9
Q

Risk Factors for Neglect: Parents/caregivers

A

Substance abuse
Adolescent parents
Poverty
Cognitive impairment
Domestic violence
Mental health issues
Lack of education
Unrealistic expectations

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10
Q

Risk Factors for Neglect: family

A

Isolation
Single-parent families
Unemployment
Family illness
History of involvement with child welfare services

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11
Q

Clinical Presentation for physical neglect

A

Poor hygiene, lack of adequate clothing or diapers, or injuries from exposure (frostbite, heat illness)

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12
Q

Clinical Presentation of supervisory neglect

A

Ingestion, injury from a firearm, dog bite, near drowning, burns or fatality

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13
Q

Clinical Presentation of emotional neglect

A

Lack of a relationship between the child & caregiver
providing a sense of emotional security
Caregiver inability to follow through with
recommendations for psychological care or services

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14
Q

Clinical Presentation og educational neglect

A
  • Chronic truancy/poor attendance
  • Homeschooling without an educational plan or activities
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15
Q

Clinical Presentation: Nutritional neglect

A
  • Undernutrition → starvation, failure to thrive
    Relative absence of subcutaneous fat in the cheeks,
    buttocks, & extremities
    Conditions associated ↓ nutrient & vitamin intake
    Short stature

Overnutrition → obesity with significant medical complications

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16
Q

Clinical Presentation: Medical neglect

A

Seriously ill child & signs of illness were not recognized,
or care not sought
Lack of adherence to tx plans &/or follow-up → serious
exacerbation of chronic health conditions
Lack of primary care visits for vulnerable children

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17
Q

Children under ___ months old are incapable of inducing
accidents or accidentally ingesting drugs or poisons on
their own

A

6

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18
Q

Risk Factors for perpetrators

A

Male
Female
Young maternal age
Single/Unmarried mother
Abused themselves
History of substance abuse

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19
Q

What might a history sound like in a patient you are suspecting abuse?

A
  • No history, denial of trauma despite severe injury, or changing history
  • Explanation inconsistent with child’s injury/developmental stage
    Short “fall” (<3 feet)
  • Severe injury explained as self-inflicted or blamed on other young children or pets
  • History discrepancies of various caregivers
    Substantial delay in seeking medical care
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20
Q

Physical Exam guidelines for head when abuse is expected?

A
  • hematoma or abnormality of skull
    Abusive head trauma (ie shaken baby syndrome)
  • Alopecia (2° hair pulling)
  • Eyes
  • Mouth (dental trauma)
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21
Q

Physical Exam: derm when suspecting abuse

A

Expose skin, examine, & document precise location &
size of any ligature marks, bites, bruises, burns or scars

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22
Q

Physical Exam: MSK when suspecting abuse

A
  • Palpate chest, abdomen, spine & extremities for tenderness
    Evidence of fractures
  • Injuries in multiple stages of healing
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23
Q

T/F any bruise is a red flag injury in infants <6 months old?

A

T

24
Q

What is red flag injuries for abuse for abuse under the age of 3?

A

Frenulum tears - May be from accidental injury (ambulating toddler) or force feeding/bottle jamming
Unexplained oral injuries (teeth, lips, palate)
Missing or fracture teeth with an absent or implausible history
Maxillary or mandibular fractures with an absent or implausible history
Bruising, lichenification, or scarring at the corners of the mouth from being gagged

25
Q

Where are accidental bruises found?

A
  • Front of the body
  • Boney prominences (extremities)
  • Forehead
26
Q

Non-accidental bruises are found:

A
  • Torso
  • Ears, cheeks, neck
  • Back, buttocks
  • Patterned
  • > 1 bruise, non-mobile infant
  • > 2 bruises, crawling child
27
Q

Red flag burn injuries in children <3 yo

A

Burns in the shape of a heated object
Immersion burns
Burns of the perineum & lower extremities
Multiple fractures in different stages of healing

28
Q

Red flag fractures in infants <6 months

A

Any fracture other than skull or clavicle
fractures in the newborn period

29
Q

Red flag fractures in infants 6-12 months

A

Any fracture other than
skull fracture
Skull fractures without
history or other than
simple linear parietal type

30
Q

Red flag fractures in 1 year olds

A

Any rib fracture
Humerus fracture, other than
supracondylar
Fractures of other long bones
Fracture without trauma history or
presenting with evidence of healing

31
Q

Red flag intracranial injuries <1 yo

A

Any subdural hemorrhage/hygroma

32
Q

Red flag fractures in 2-3 year olds

A

Fracture without trauma history or
presenting with evidence of healing

33
Q

Red flag intracranial injuries >1 yo

A

Unexplained subdural hematoma without history of high-energy trauma (eg, motor vehicle collision, long-distance fall)

34
Q

Red flag visceral injuries <1 yo

A

Any visceral injury

35
Q

Red flag visceral injuries >1 yo

A

Traumatic visceral injury unexplained by motor vehicle collision or verified history of accidental high-energy blow to the abdomen*

36
Q

Diagnostic testing appropriate if suspecting abuse:

A

Skeletal survey
Intraabdominal CT
Non-contrast CT of head
CBC with platelet count , PT, PTT, BMP, liver enzymes, alkaline phosphatase, calcium & phosphate

37
Q

What testing is Gold standard for suspected abdominal trauma?

A

Intraabdominal CT

38
Q

Sexual assault

A

Attempted sexual touching of another person without their
consent (children cannot give consent) sexual intercourse (rape)
oral-genital or anal-genital contact (sodomy)
touching the private parts of another person for sexual
gratification (fondling)

39
Q

Sexual abuse

A
  • A child engaging in sexual activities (see above) for which he/she cannot give consent, is unprepared for developmentally, cannot comprehend; &/or an activity that
    violates the law or social taboos of society, whether the
    victim is clothed or unclothed.
  • It also includes non-touching abuses Exhibitionism
    Voyeurism
    Involving the child in pornography
40
Q

What are “Grooming” behaviors?

A
  • Gaining access to children through caretaking
  • Targeting children
    Bribes, gifts, games
  • Systematic desensitization of victims
    Touch
    Talk about sex
    Persuasion
41
Q

Risk Factors: perpetrators of sexual assault

A

Male
Trusted adult acquaintances
US Health & Human Services
“Father” → 21%
“Other relatives” → 19%
Adolescence
Peers may constitute
the group of
perpetrators

41
Q

Risk Factors: victims of sexual assault

A

All social, cultural, & economic backgrounds
*Poor parent-child relationships
*Poor relationships between parents
*Absence of a protective parent
*Presence of a nonbiologically related male in the home

42
Q

What is often the chief complaints given for sexual assault?

A

Routine care
Urinary Tract Infections
Enuresis/Encopresis
Sleep Disturbance
Behavioral Changes
Abuse

43
Q

Diagnostic of sexual abuse

A

STI (N. gonorrhoeae, Syphilis)

44
Q

What happens when sexual abuse is confirmed?

A
  • Interview should be conducted by a trained child
    protection investigator & forensic examiner
  • ↓ need to repeat painful & distressing info
  • Best if interviewed without the parents
    Patient comfort & exam effectiveness may be facilitated by the parent
45
Q

Interview guidance for gathering a sexual abuse history

A

Open ended questioning (never leading)
“Has someone ever touched you in a way you
didn’t like or that made you feel
uncomfortable?”
“Tell me more,” “& then what happened?”
Avoid any display of shock or disbelief
Information to obtain in a gentle, nonthreatening way

46
Q

Helpful tip for gathering a sexual abuse history

A

Helpful Tip: Using a doll or drawing may help
the child describe what happened

47
Q

Sexual assault nurse examiners (SANEs)

A

SANEs are certified by examination through the Commission for Forensic Nursing Certification.
Requirements before examination include an
unrestricted RN license, 2 years of nursing experience,
40 hours of coursework, & competency in supervised
sexual assault examination

48
Q

Sexual assault forensic examiner (SAFE)

A

Physicians, PAs, & nurses
The Department of Justice establishes national training
standards for SAFEs

49
Q

What does “First do no harm” mean?

A

The exam should NOT result in additional
harm/trauma

50
Q

Sexual Abuse Physical Exam: Oral cavity

A

Bruising/petechiae
of the palate
Frenulum tearing
Superior,
inferior, linguae

51
Q

T/F if a female is G1-2 and being assessed for sexual assault, a Speculum exam is NOT require unless there is active
bleeding of an unknown etiology

A

T

52
Q

Emotional & Psychological sequelae of abuse

A

Suicide, substance-use d/o, anxiety &
depression, violence, & early death
↑ adverse childhood experiences → ↑ risk

53
Q

About 80% of 21-year-olds who were abused as children met criteria for _____

A

at least one psychological disorder.

54
Q

General indicators of human trafficking

A
  • Shares a scripted or inconsistent history
  • Is unwilling or hesitant to answer questions about the injury or illness
  • Is accompanied by a controlling individual who does not let the patient speak for themselves, refuses to let the
    patient have privacy, or who interprets for them
  • Demonstrates fearful or nervous behavior or avoids eye contact, resists assistance or demonstrates hostile behavior
  • Is unable to provide his/her address, not aware of his/her location, the current date, or time
  • Is not in possession of his/her identification documents
  • Is not in control of his or her own money
  • Signs of malnourishment, substance abuse, or poor dental hygiene
55
Q

Sex trafficking indicators

A
  • Patient is under the age of 18 and is involved in the commercial sex industry
  • Has tattoos or other forms of branding (Ex// tattoos that say “Daddy,” “Property of…,” “For sale”
  • Reports a high number of sexual partners
  • Does not have appropriate clothing for the weather or venue
  • Uses language common in the commercial sex industry
  • Multiple STIs
  • Multiple pregnancies, miscarriages, and/or terminations

Pediatrics Exam 4 (7 decks)

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