Child and Youth Maltreatment Flashcards
What is the appropriate term to describe a bruise that you think was the result of abuse?
inflicted (not intentional b/c cannot determine intentionality from a medical assessment)
What are the most common injuries sustained from child maltreatment?
skin injuries
What are common characteristics of bruises of accidental childhood trauma?
- relatively small, oval to round in shape, non distinct borders, located above or near bony prominences on the front of the body (often the forehead, knees or shins)
- no recognizable shape or pattern
- appropriate for child’s developmental level
What are some red flags for inflicted injury in a child with bruising?
- bruises in babies who are not yet cruising
- bruises on the ears, neck, feet, bum or torso (including chest, back, abdomen, genitalia)
- bruises not on the front of the body and/or overlying bone
- bruises that are usually large or numerous
- bruises that are clustered or patterned
- bruises that do not fit with the causal mechanism described
What is the main differential for bruises in a nonmobile child?
- maltreatment
- coagulopathy
- these always need to be worked up
What is the approach to dating bruises?
-neither colour nor the progressive changes in colour are reliable indicators of bruises
What is the most common acquired disorder of coagulation?
ITP
What is the most common inherited coagulation disorder? What are the 2nd and 3rd most common?
1) von Willebrand disease (up to 1% of population)
2) hemophilia A (factor 8)
3) hemophilia B (factor 9)
- *vWD is not always diagnosed at high rates in childhood b/c it’s presentation is more subtle
- *hemophilia A is more commonly diagnosed in peds than vWD b/c its presentation is more severe
What are some medical conditions associated with bruising?
- meningococcemia
- malignancy
- nutritional deficiencies (eg Vit K, vit C)
- severe systemic illness (eg DIC)
- connective tissue disorders (eg Ehlers Danlos, OI)
- autoimmune or inflammatory d/o (eg ITP, HUS, HSP)
- striae
- Monoglian spots/slate-grey nevi
- hemangiomas
- EM
- eczema
- incontinenti pigmenti
- cultural practices like cupping
- skin staining (from dye or ink)
What are some key points on history that suggest the presence of a possible bleeding disorder?
- postcircumcision bleeding
- birth cephalohematoma
- umbilical stump bleeding or delayed separation
- postvenipuncture bleeding
- petechiae at clothing line pressure sites
- bruising at sites of object pressure (e.g. infant car seat fasteners)
Which children with bruising need labs done?
- when results may impact the health and/or child welfare outcome
- if there is a clinical suspicion of a bleeding disorder
- unexplained bruising in a non-cruising baby
What are the recommended first line labs for bruising and suspected maltreatment?
- CBC
- smear
- PTT, INR
- fibrinogen
- von Willebrand studies
- blood group (for interpretation of vWD studies)
- Factor VIII and IX
- liver function tests (for secondary platelet dysfunction)
- renal function tests (for secondary platelet dysfunction)
What is the work up of a kid
- labs
- skeletal survey
- ophthalmology assessment
- consider head imaging (CT if acute, MRI if old, HUS iS NOT GOOD ENOUGH); if suspect abusive head trauma must do CT/MRI
How should documentation of physical findings be done in a suspected inflicted trauma case?
- with a line diagram
- indicate size, shape, colour, location, contour
- photographs (medical photography)
- duty to report to child protection services
What is the collection of findings in shaken baby syndrome?
- intracranial hemorrhage
- retinal hemorrhage
- rib fractures and fractures at the ends of long bones
Which age group is particularly at risk for abusive head trauma? Why?
-any age but especially infants
Could a resuscitation attempt results in the same constellation of findings as shaken baby?
-nope
How is the brain injured in abusive head trauma?
- repeated whipping back and forth of the head with rotational forces
- shearing of blood vessels, causes subdural hematoma
- brain injury as it hits the skull
- nerve injury
- cerebral edema
- hypoxia
What are S+S of abusive head trauma?
- nonspecific
- if mild can present like a viral illness
- irritability
- lethargy
- vomiting
- seizures
- abnormal breathing
- death
What are the long term effects of abusive head trauma?
-no effects to permanent disabilities including developmental, seizures, paralysis, blindness, death
What are some of the common triggers for abusive head trauma?
- exhaustion
- frustration
- stress
- toileting difficulties
- feeding difficulties
- crying
Which babies are shaken most often and by whom?
-male babies
What are some risk factors for abusive head trauma?
- social isolation
- family violence
- substance abuse
- psychiatric conditions
- adult having been abused as a child
- poor parental attachment
- inadequate knowledge of child development
