Child and Elder Abuse :(

Question 1

What is a physician’s primary role in abuse cases?

Answer 1

To report, not investigate. want enough info to be able to report

Question 2

What are risk factors for child maltreatment (only the ones in red)

Answer 2

Anything that increases caretaking difficulty

Fussy/colicky infant
Hyperactive/behavior problems
Illness
Non-biologic relationship with caregiver 
Prematurity 

Caregiver abusing substances also increases risk

Question 3

What are the four main types of child abuse?

Answer 3

Neglect
Emotional
Physical
Sexual

Question 4

What is the most common cause of death in abused children?

Answer 4

Neglect :(

Question 5

What qualifies as child neglect?

Answer 5

Failure to provide basic needs

Physical, emotional, educational, medical

Question 6

What should well-child visits include?

Answer 6

Nutrition
Safety and injury prevention
Developmental stages 
Dental and eye care recommendations 
Educational needs

Question 7

What is a physicians role when suspecting neglect?

Answer 7

Full medical hx
Psychosocial hx
Complete physical exam
Contact CPS if needed

Question 8

If a diagnosis of neglect is unclear, what steps can you take?

Answer 8

Arrange home visit by social worker or home nurse

arrange well check w police force

Question 9

What are some behavioral patterns that might suggest emotional abuse?

Answer 9

Social withdrawal
Aggression
Eating disorder
Failure to thrive
Developmental delay
Emotional disturbances
Sleep disorders 
Self-injurious behaviors

Question 10

When should emotional abuse be reported to CPS?

Answer 10

If it seems to be recurrent or shows a possibility of imminent harm to the child

Question 11

What are some suspicious signs on a child PE?

Answer 11

Posterior rib fractures

Scapular fracture
Spinous process
Sternal fracture
Cigarette burns
Metaphyseal lesions

Question 12

What actions should be taken if you see evidence of physical abuse on child PE?

Answer 12

meet w caregiver to gather information
Document carefully
Photograph images and save to secure location

Question 13

Ex of non-touching sexual abuse

Answer 13

Expose child to pornography

Neglectfully allow child to see or hear sexual activity

Question 14

Ex of touching sexual abuse

Answer 14

Fondling
Touching or making child touch sexual organs
Penetration of labia or anus by an object for non-medical purpose
Oral-genital contact

Question 15

Ex of sexual expolitation

Answer 15

Engaging a child for purposes of prostitution
Using child to film, photograph, or model pornography
Human trafficking or sexual slavery

Question 16

What should be done if you suspect sexual abuse?

Answer 16

Document using quotations

PE for dysuria, anal or vaginal bleeding, vaginal discharge, or pain on defecation

Question 17

Questions in minimal facts interview

Answer 17

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)

Question 18

What are high risk population for sexual abuse of child?

Answer 18

Intellectually disabled
Deaf
LGBTQ
Transgender

Question 19

What class misdemeanor is failure to report in MO and Ks respectively?

Answer 19

MO: Class A misdemeanor
KS: Class B misdemeanor, even if someone else has reported it as well

Question 20

What are victim risk factors of elder abuse?

Answer 20

Dementia, psychiatric diagnosis
Physical dependence
Incontinence

Question 21

Perpetrator characteristic of elder abuse?

Answer 21

Substance abuse
Financial dependence
Poverty and social isolation

Question 22

What are the different types of elder abuse?

Answer 22

Physical
Sexual
Psychological
Financial
Neglect

Question 23

Signs of abuse on elder PE

Answer 23

Bruising
burns
unexplained injuries or injuries healing at different rates
Findings of sexual abuse

Question 24

Physicians role in suspected elder abuse

Answer 24

report to senior protective services

Document carefully w photos, xrays, written documentation