Child/Elder Abuse Flashcards
Physicians primary role in the setting of child or elder abuse
To report, not investigate
If child abuse is suspected, what should the physician attempt to do, in hopes of gathering more information?
Separate the child from the guardian for a PE, the child may reveal more information during this time
Risk factors for child maltreatment
- Fussy, colicky infant
- < 1 y/o
- Behavioral problems (hyperactive)
- Medical fragility, illness
- Non-biological relationship with caregiver
- Prematurity
- Unwanted pregnancy
- Special needs infant/child
- Twins
Risk factors that make a caregiver more like to abuse a child
- Criminal history
- Substance abuse
- Mental health hx
- Misconceptions about child care/child development
- Teen parents (esp. without family support)
- Non-biological father figure in home
Define child abuse
A recent act or failure to act that results in death, serious physical or emotional harm, sexual abuse or exploitation or imminent risk of serious harm
- Involves a child
- Carried out by a parent or caregiver who is responsible for the child’s welfare
Four main types of child abuse
- Neglect
- Emotional
- Physical
- Sexual
What characterizes neglect of a child?
Failure to provide for a child’s basic needs:
- Physical (food, clothing, shelther, hygiene)
- Emotional (love, security, affection)
- Educational (improper enrollment)
- Medical (no medical/dental care)
What is the most common type of child abuse?
Neglect
What is the most common cause of death in abused children?
Neglect
Well-child visits are essential to assess for neglect. What should be assessed during these visits?
- Nutrition
- Safety, injury prevention
- Developmental stages
- Dental and eye care recommendations
- Educational needs
What options are available if a diagnosis of neglect is unclear?
- Arrange a home visit by a social worker or home nurse
- Request that the local police perform a “well check”
What is one mandatory thing a physician should do when suspecting child abuse?
Contact Child Protective Services, even when in doubt
What behavioral patterns may suggest emotional abuse?
- Social withdrawal
- Excessive anger, aggression; emotional disturbances
- Eating disorders
- Failure to thrive
- Developmental delays
- Sleep disorders
- Self-injurious behaviors
What suspicious exam findings may clue into child abuse?
- Bruises, bites
- Abd trauma
- Posterior rib fx
- Skull fx (infants)
- Scapular fx
- Sternal fx
- Fx of spinous process
- Cigarette burns
- Metaphyseal lesions
Three types of sexual abuse
- Non-touching
- Touching
- Exploitation
Examples of non-touching sexual abuse
- Expose a child to pornography
- Neglectfully allow child to see/hear active sexual activity
Examples of touching sexual abuse
- Fondling
- Touching a child or making a child touch sexual organs
- Penetration of labia or anus by object for non-medical purposes
- Oral-genital contact
Examples of sexual exploitation
- Engaging a child for purposes of prostitution
- Using a child to film, photograph or model pornography
- Human trafficking; sex slavery
In what age range are most victims of sexual abuse?
9-12 years old
Are there usually physical findings of sexual abuse on PE?
No
What is the most important part of a patient encounter to be documented in regards to sexual abuse?
The history
A minimal facts interview helps to establish what?
The “who, what, when, where, how” of a sexual abuse case
Why should you avoid asking a child when something occurred when inquiring about sexual abuse?
Children have difficulty with spatial timing and can become confused
Very high risk populations (5) to be victims of sexual abuse
- Intellectually disabled (4x more likely)
- Deaf children (50%)
- Developmentally disabled adults
- 83% of females
- 32% of males
- LGBTQ (3x more likely)
- Transgender (50%)
Risk factors which put an elderly individual at risk of abuse
- Dementia, psych diagnosis
- Physical dependence
- Incontinence
- > 75 y/o and female
- Low income
Those found to abuse the elderly tend to have what characteristics?
- Substance abuse disorder
- Male
- Hx of violent behavior
- Financial dependence on the victim
- Are a close caregiver or family member of the victim
Types of elder abuse
- Physical
- Hitting, slapping, physical/chemical restraint
- Sexual
- Rape, unwanted touching, innuendo
- Psychological
- Threaten to institutionalize or to withdrawal Rx, nutrition and hydration
- Financial
- Theft, blackmail, coercion to change will
- Neglect
- Failure to provide goods/services necessart for maintaining health
Signs of neglect in the eldery
- Lack of needed nutrition
- Poor personal care
- Smells of urine when incontinent
- Lack of needed medication or health aids
- Glasses, dentures, hearing aids
What kinds of bruises seen on PE may indicate elder abuse?
- Bilateral bruises on the inner surface of the arms
- From being grabbed
- Bruising of soft tissue
- Not over bony prominence
What kinds of fractures may indicate elder abuse?
- Fractures at different stages of healing
- Spiral fx
- Caused by twisting of limbs
Physicians role when suspecting elder abuse
- Report to senior protective services
- Document carefully
- Photographs if possible
- X-rays
- Diagram injuries
- Written documentation
