Child and Youth Maltreatment Flashcards
what is the purpose of child death review
Purpose is to conduct a comprehensive multidisciplinary review of child deaths to better understand how and why children die
what are 5 safety preventions that have come from child death review
cribs for families in need folic acid supplementation safe sleeping water safety initiatives smoke detector installation tougher penalties for drinking and driving Policies and training for reporting abuse and neglect Suicide prevention for teachers
what are 5 clinical red flags for inflicted trauma
age <1
high risk fractures (Rib fractures, Metaphyseal fractures, Humerus fracture < 18 months, Femur fracture in a non-ambulatory child)
multiple fractures (3 or more fractures is more likely to be abuse)
fractures at different ages
other injuries
what are 4 history red flags for inflicted trauma
No history of trauma/unwitnessed injury
History incompable with age/developmental stage OR with injury
History changes with repetition
Delay in seeking medical attention
what are the recommended lab investigations for inflicted trauma?
Complete blood count
Renal and liver function tests
Serum calcium, phosphate and alkaline phosphatase
Urinalysis
When clinically indicated:
parathyroid hormone, 25-hydroxy-vitamin D
serum copper, ceruloplasmin
what is recommended in any child <2 years of age when there is concern for physical maltreatment?
skeletal survey is recommended for any child <2 years of age when there is concern for physical maltreatment
Ddx for skeletal injury in a young child (6 main categories)
i. Trauma (Birth-related, Accidental, Inflicted)
ii. Genetic bone disorder (Osteogenesis imperfecta, Menkes disease, Infantile cortical hyperostosis, Hypophosphatasia)
iii. Nutrional/metabolic disorder (Vitamin D deficiency rickets, Osteopenia of prematurity, Copper deficiency, Chronic renal insufficiency, Scurvy)
iv. Infection (Osteomyelitis, Congenital syphilis)
v. Toxicity (Hypervitaminosis A, Methotrexate toxicity)
vi. Neoplasc disorder (Leukemia, Langerhans cell hisocytosis)
what are 5 red flags on exam for inflicted injury in a child with bruising
Bruises in babies who are not yet cruising
Bruises on the ears, neck, feet, buttocks or torso (torso includes chest, back, abdomen, genitalia)
Bruises not on the front of the body and/or overlying bone
Bruises that are unusually large or numerous
Bruises that are clustered or patterned (patterns may include handprints, loop or belt marks, bite marks)
Bruises that do not fit with the causal mechanism described
what are the recommended lab tests for a child with suspected inflicted bruising
Complete blood count
Peripheral blood smear
Prothrombin time/International normalized ratio
Activated partial thromboplastin time
Fibrinogen
von Willebrand studies
Blood group (for interpretation of von Willebrand levels)
Factor VIII level
Factor IX level
Liver function tests (for secondary platelet dysfunction)
Renal function tests (for secondary platelet dysfunction)
key points on history for a bleeding disorder infant and child (5)
infant:
Postcircumcision bleeding
Birth cephalohematoma
Umbilical stump bleeding or delayed stump separation
Postvenipuncture bleeding
Macroscopic hematuria
Petechiae at clothing line pressure sites
Bruising at sites of object pressure, such as infant car seat fasteners
child:
Spontaneous, easy or excessive bruising
Mucocutaneous bleeding (eg, gingival bleeding)
Epistaxis that is spontaneous, lasts >10 min or requires medical treatment
Bleeding from minor wounds that lasts >15 min or recurs within seven days
Prolonged bleeding after surgical procedures
Bruises with palpable lumps beneath them
Joint swelling with minor injury
Blood in the stool or urine
Menorrhagia
Unexplained anemia
History of blood transfusion
Most common acquired disorder of coagulation:
Most common inherited disorders of coagulation:
ITP 1. Factor VIII (Hemophilia A) 2. vWD (this is the most common overall if you include adults) 3. Factor IX (Hemophilia B)
what do bruises look like that result from accidental trauma
Small, oval to round no distinct borders Located above or near bony prominences on the front of the body (forehead, knees, shins) without a recognizable shape or pattern
What are 5 things that physical abuse puts children at risk for in the future
Physical injury poor mental health impaired relationship with parents weaker internalization of moral values antisocial behaviour tolerance of violence in adulthood
what are 3 findings strongly suggestive of abusive head trauma
traumatic retinoschisis (shearing of the layers of the retina)
diffuse multilayered retinal hemorrhages
subdural hemorrhage
what are 4 objectives of a child and youth death review
- improved criminal investigations of child homicide
- trends and risk factors of child deaths
- safety of siblings and others in the home
- consistent reporting of the cause of every child death
