Child Abuse & Neglect Flashcards
Child Maltreatment
any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act of failure to act which presents an imminent risk of serious harm
4 Subcategories:
- Neglect (74.8%)
- Psychological maltreatment
- Physical abuse (18.2%)
- Sexual abuse (8.5%)
Fatal abuse: 2.4 in 100,000
Prognosis of victims <5 years (if no treatment):
-Short Term
50%+ further abuse
5% mortality and 25% serious morbidity
20% of siblings of abused child will have abuse findings
-Long Term
90% of abusers were abused
95% of prostitutes were abused
School failure, violent acts, less socioeconomic status, early sexual activity all higher in abused children
Child Risk Factors for Maltreatment
Children fatally injured are more likely to be males under 3 years (< 1 year have highest victimization rate)
Females are more likely to experience maltreatment
Premature Birth & Disability in child
Boys more likely to be physically abused
Girls more likely to be sexually abused
Maltreatment victims: 44% Caucasian; 22% Hispanic; 20.7% African American
Children with behavioral and special health-care needs, those with difficult temperaments, and those who are chronically ill are more risk
Family/Environmental Risk Factors for Maltreatment
- Poverty, Children with special health-care needs, parental substance abuse, and parental mental health disorders
- The presence of a nonparental caregiver in the home, parents with low educational levels, families with large numbers of children, and parental history of being abused/neglected
Neglect
Failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child’s health, safety, and well-being are threatened with harm
Neglect is the most common form of child maltreatment and the consequences of neglect persist well into adulthood; leading cause of mortality in child maltreatment
RISK FACTORS for neglect: poverty, parental history of mental health disorders, substance abuse, paternal physical disability, and certain cultural practices
SEE BOX 24.2
Willful and Educational Neglect
Willful Neglect: a situation in which a parent knows how to seek resources for their family refuses to do so
Educational Neglect: parent makes no provisions for the child to attend school
Psychological Maltreatment
“Injury to the psychological capacity or emotional stability of the child as evidenced by an observable or substantial change in behavior, emotional response, or cognition” and injury as evidenced by “anxiety, depression, withdrawal, or aggressive behavior”
RISK FACTORS: Multiple family stressors, family conflict, parental mental health disorders, or substance abuse
Children with chronic illness or those who are “different” from their siblings may become targets
Psychological maltreatment may contribute to FTT, speech or sleep disorders, or a wide range of behavioral and emotional problems
Consistent or recurrent negative parental behaviors, willful cruelty, or unjustifiable emotional punishment are key indicators of psychological maltreatment
Types: 1- Spurning 2- Terrorizing 3- Isolating 4- Exploiting/Corrupting 5- Denying Emotional Responsiveness 6- Mental health/medical/educational neglect
Physical Abuse
Maltreatment involving “nonaccidental physical injury to the child”
May include: human trafficking; parent or caregiver shaking, striking, or throwing the child in the moment of frustration or anger; unreasonably severe corporal or unjustifiable punishment, or caused by intentional, deliberate assault
Medical child abuse or Munchausen Syndrome by Proxy (MSBP): when a parent or caregiver falsifies the history or fabricates an illness in a child in order to receive attention from the medical community (“the child receives unnecessary and harmful or potentially harmful medical care at the instigation of a caretaker”)
Red flags in the history include:
- Injury that is unusual for a specific age group
- Injuries are unexplained or implausible; explanation does not match the type or mechanism of injury; or child is not developmentally capable of reported behavior
- Caregiver delays seeking care for the child, seeks inappropriate care, or the age of injury is inconsistent with history
- Child, parent or caregiver, or both hide injury or child is kept out of school (isolated)
- Presence of triggering behaviors
- Report of a crisis or stressful time for the family or intimate partner violence (IPV)
- Problem with substance abuse in the family
“TEN 4” injuries: Injuries occurring on torso, ear, neck and in children less than 4 years and in ANY infant under 4 months old
Behaviors to investigate:
- Hypervigilance or difficulty regulating emotions
- Exaggerated emotional responses in the face of the triggers
- Sleep disturbances
- Anger/irritability or withdrawal
Leading causes of death: intracranial hemorrhage and abdominal injury
Sexual abuse
Can be defined to include acts of sexual assault or sexual exploitation of minors, or both
The perpetrator is usually known to the child and is often a “trusted” adult
SEE TABLE 24.6
1 in 7 endangered runaways reported will likely be a sex trafficking victim; 88% of these children were in the care of social services or foster care when they ran
RISK FACTORS for Human Trafficking include: Children and adolescent runaways, history of sexual assault/abuse, children and adolescents with substance abuse or living in a home with parental substance abuse, family dysfunction, and LGBTQ youth
Violence
The outcome of aggressive behavior then becomes distractive and results in physical injury to people or damage to property
Lab workup recommendations
CBC with platelet count, PT, aPTT, INR, vWF panel (Includes Factor VIII), Factor IX
Include above labs and fibrinogen level with abusive head trauma
16% of children evaluated for excessive bruising found to have evidence of a bleeding disorder (most common is von Willebrand disorder)
Bites
Adult dental arch size = 3.0-4.5 cm
Child = < 3.0 cm
Burns
Thermal (liquid) is most common burn (80% from tap water)
Water temperature of bath is usually 101°F
For adults, water is painful at 112 to 114°F
Temperature of 140°F can cause tissue injury with a hot water splash
RISK FACTORS of burns due to child abuse:
- Boys age 2 to 3 years and older
- Lower socioeconomic status
- Single parent family
- Often associated with toilet training and excessive crying
10 to 18 months of age 35% of children can climb into a bathtub
Complete a skeletal survey on children under 5 years with inflicted burns
and…for large burns, also do AST and ALT looking for occult abdominal injury
Fractures
Look for multiple stages of healing, history doesn’t match the injury, epiphyseal-metaphyseal fractures, age of the child, location of fracture (unexplained rib fractures; skull fractures under 2 years)
Abusive Head Trauma (AHT)
Other names: nonaccidental head injury, inflicted traumatic brain injury, shaken baby syndrome, shaken impact syndrome
65% of surviving children are left with significant disability
Average age is 6 months; most are under 12 months; unlikely beyond 24 months
Diagnosis is confirmed as the following conditions are met:
- The infant has signs of head injury (subdural for subarachnoid hemorrhages, cerebral edema, or skull fractures)
- Retinal hemorrhages are present (80% of cases)
- No other obvious accident cause of injury
Caregiver fabricated illness (Munchhausen Syndrome by proxy)
Most common presenting symptoms: Bleeding from the various sites 44%; seizures 42%; CNS depression 19%; Apnea 15%
