Child and Elder Abuse :( Flashcards
What is a physician’s primary role in abuse cases?
To report, not investigate. want enough info to be able to report
What are risk factors for child maltreatment (only the ones in red)
Anything that increases caretaking difficulty
Fussy/colicky infant Hyperactive/behavior problems Illness Non-biologic relationship with caregiver Prematurity
Caregiver abusing substances also increases risk
What are the four main types of child abuse?
Neglect
Emotional
Physical
Sexual
What is the most common cause of death in abused children?
Neglect :(
What qualifies as child neglect?
Failure to provide basic needs
Physical, emotional, educational, medical
What should well-child visits include?
Nutrition Safety and injury prevention Developmental stages Dental and eye care recommendations Educational needs
What is a physicians role when suspecting neglect?
Full medical hx
Psychosocial hx
Complete physical exam
Contact CPS if needed
If a diagnosis of neglect is unclear, what steps can you take?
Arrange home visit by social worker or home nurse
arrange well check w police force
What are some behavioral patterns that might suggest emotional abuse?
Social withdrawal Aggression Eating disorder Failure to thrive Developmental delay Emotional disturbances Sleep disorders Self-injurious behaviors
When should emotional abuse be reported to CPS?
If it seems to be recurrent or shows a possibility of imminent harm to the child
What are some suspicious signs on a child PE?
Posterior rib fractures
Scapular fracture Spinous process Sternal fracture Cigarette burns Metaphyseal lesions
What actions should be taken if you see evidence of physical abuse on child PE?
meet w caregiver to gather information
Document carefully
Photograph images and save to secure location
Ex of non-touching sexual abuse
Expose child to pornography
Neglectfully allow child to see or hear sexual activity
Ex of touching sexual abuse
Fondling
Touching or making child touch sexual organs
Penetration of labia or anus by an object for non-medical purpose
Oral-genital contact
Ex of sexual expolitation
Engaging a child for purposes of prostitution
Using child to film, photograph, or model pornography
Human trafficking or sexual slavery
What should be done if you suspect sexual abuse?
Document using quotations
PE for dysuria, anal or vaginal bleeding, vaginal discharge, or pain on defecation
Questions in minimal facts interview
Can you tell me what happened to you (__ touched me -Who)
What did he touch you with (what)
Where did he touch you (where)
Where were you when this happened (where)
Don’t ask when, instead ask if it has happened more than one time
Did he touch you under or over your clothes (how)
What are high risk population for sexual abuse of child?
Intellectually disabled
Deaf
LGBTQ
Transgender
What class misdemeanor is failure to report in MO and Ks respectively?
MO: Class A misdemeanor
KS: Class B misdemeanor, even if someone else has reported it as well
What are victim risk factors of elder abuse?
Dementia, psychiatric diagnosis
Physical dependence
Incontinence
Perpetrator characteristic of elder abuse?
Substance abuse
Financial dependence
Poverty and social isolation
What are the different types of elder abuse?
Physical Sexual Psychological Financial Neglect
Signs of abuse on elder PE
Bruising
burns
unexplained injuries or injuries healing at different rates
Findings of sexual abuse
Physicians role in suspected elder abuse
report to senior protective services
Document carefully w photos, xrays, written documentation
