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NMSP Exam 3 > Child/Elder Abuse > Flashcards

Child/Elder Abuse Flashcards

1
Q

What is a physician’s primary role in abuse?

A
  • Report, not investigate
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2
Q

What should you do when you suspect abuse?

A
  • If possible, separate child from adult for PE to see if child shares additional information
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3
Q

How should you ask questions to children that are suspected of being abused?

A
  • Avoid accidentally leading them into a false memory because children are eager to please you
  • Ask a couple of question. Stick to the facts, not labels
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4
Q

What are some child risk factors for child maltreatment?

A
  • Fussy, colicky infant
  • <1 year old
  • Behavioral problems (hyperactive)
  • Medical fragility, illness
  • Non-biologic relationship with caregiver
  • Prematurity
  • Unwanted pregnancy or infant
  • Special needs infant/child
  • Twins
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5
Q

What are some caregiver risk factors for child maltreatment?

A
  • Criminal history (child in CPS custody; prior termination of parental rights)
  • Substance abuse
  • Mental health history
  • Misconceptions about child care or child development
  • Teen parents
  • Non-biological father figure in home
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6
Q

What are some family/environmental risk factors for child maltreatment?

A
  • Social isolation; lack of social support
  • Intimate partner violence
  • High local unemployment rates, poverty
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7
Q

What is Child Abuse defined as?

A
  • 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; and is carried out by a parent or caregiver who is responsible for the child’s welfare
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8
Q

What are the four main types of child abuse?

A
  1. Neglect
  2. Emotional
  3. Physical
  4. Sexual
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9
Q

What is neglect?

A
  • Failure to provide for a child’s basic needs like:
    1. Physical (food, clothing, shelter, hygiene)
    2. Emotional (love, security, affection, emotional support)
    3. Educational (improper enrollment, not supervising school attendance)
    4. Medical (delay or refusal to seek medical/dental care resulting in child’s wellbeing)
  • *Most common type of child abuse and most common cause of death in abused children**
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10
Q

What should a physician include in every well-child visit?

A
  • Nutrition
  • Safety, injury prevention
  • Developmental stages
  • Dental and eye care recommendations
  • Educational needs
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11
Q

What is the physician’s role when suspecting neglect?

A
  • Full medical history
  • Psychosocial history
  • Complete physical exam
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12
Q

What are the options if the diagnosis of neglect is unclear?

A
  • Arrange a home visit by a social worker or home nurse
  • Arrange a “well check” by local police force
  • Ensure safety of child and contact child protective services, even when in doubt (check with attending before doing this)
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13
Q

What is emotional abuse?

A
  • Difficult to recognize in clinical practice

- Remember definition: results in demonstrable harm to child

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14
Q

What are some behavior patterns that may suggest emotional abuse?

A
  • Social withdrawal
  • Excessive anger, aggression
  • Eating disorders
  • Failure to thrive
  • Developmental delays
  • Emotional disturbances
  • Sleep disorders
  • Self-injurious behaviors
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15
Q

What is the physician’s role when suspecting emotional abuse?

A
  • If it appears isolated and no immediate danger to child –> Can recommend family therapy, parenting classes, supportive therapy, behavior therapy for parents
  • If it appears recurrent or possibility of imminent harm to child –> report to child protective services
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16
Q

What are some suspicious signs on the physical exam?

A
  • Bruises
  • Bites
  • Burns
  • Fractures
  • Abdominal trauma
  • Head trauma
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17
Q

What else is suspicious on a physical exam that may be life threatening?

A
  • Posterior rib fractures
  • Retinal hemorrhages
  • Skull fractures
  • Long bone fractures in non-ambulatory children <2 years
  • Scapular fractures
  • Spinous process
  • Sternal fracture
  • Cigarette burns
  • Metaphyseal lesions
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18
Q

What are you looking for in a physical exam?

A
  • Unusual distribution or location of lesion
  • Pattern of bruises or marks
  • Bite or handprint bruise of adult size
  • Burn with clear margins and uniform depth
  • Burn with stocking or glove distribution
  • Lesions of various healing stages/ages
  • Reported mechanism of injury is inconsistent with the extent of trauma/injury
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19
Q

What are some actions a physician you can take?

A
  • Meet separately with caregiver to gather information
  • Document carefully
  • Photograph injuries. Download photos to a secure location. Remove immediately if a personal device was used
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20
Q

What is sexual abuse defined as?

A
  • The employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or to assist any other person to engage in, any sexual explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children
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21
Q

What are the three types of sexual abuse?

A
  1. Non-touching
  2. Touching
  3. Exploitation
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22
Q

What are some examples of non-touching sexual abuse?

A
  • Expose child to pornography

- Neglectfully allow child to see/hear active sexual activity

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23
Q

What are some examples of touching sexual abuse?

A
  • Fondling
  • Touching or making a child touch sexual organs
  • Penetration of labia or anus by an object for non-medical purposes
  • Oral-genital contact
24
Q

What are some examples of sexual exploitation?

A
  • Engaging a child for purposes of prostitution
  • Using a child to film, photograph, or model pornography
  • Human trafficking; sexual slavery
25
Q

Who are the most likely perpetrators of sexual abuse?

A
  1. Stepfather
  2. Boyfriend of mother
  3. Uncles or older siblings
26
Q

What is the age range of most victims of sexual abuse? Who is most likely targeted?

A
  • 9-12 years old
  • 50% of cases are within the family
  • 60% are female
27
Q

What is the percentage of victims that have never told anyone they were sexually abused?

A
  • 50-70%
28
Q

What are some stats with male sexual abuse victims?

A
  • 5x more likely to cause teen pregnancy
  • 3x more likely to have multiple sexual partners
  • 2x more likely to have unprotected sex
29
Q

What is the physician’s role when suspecting sexual abuse?

A
  • Usually NO physical findings on PE
  • History is most important to document
  • Document using quotations
  • Do PE ASAP for dysuria, anal or vaginal bleeding, vaginal discharge, or pain on defecation
  • Prepubertal child- do not touch hymen and usually should not use speculum
30
Q

What is important to remember during the evaluation of sexual abuse?

A
  • No single behavior, sign, or symptom is diagnostic
31
Q

What should be of increased concern when evaluating sexual abuse?

A
  • Puts mouth on other child/adult’s sex parts
  • Puts objects in vagina or rectum
  • Touches another child’s sex parts
  • Asks others to engage in sexual acts
  • Tries to have sexual intercourse with another child or adult
  • Pretends dolls or stuffed animals are having sex
  • Tries to undress other children against their will
  • When kissing, tries to put their tongue in other person’s mouth
  • Draws sex parts when drawing pictures of people
32
Q

Why would a PE be normal in sexual abuse?

A
  • Sexual abuse can be non-injurious
  • To “reuse” the victim (not get caught)
  • Delay between incident and seeing physician (minor injuries heal quickly)
33
Q

What does a normal PE mean in suspected sexual abuse?

A
  • It does NOT mean the child is lying or exonerate alleged perpetrator
34
Q

What is the minimal facts interview?

A
  • Who
  • What
  • When
  • Where
  • How
35
Q

What is something important to remember when doing a minimal facts interview?

A
  • Young children are poor at spatial timing so ask “did this happen one time or more than one time”
36
Q

What is a good question to ask to get the Who?

A
  • Can you tell me what happened to you?

- They respond with Joe touched me

37
Q

What is a good question to ask to get the What?

A
  • What did he touch you with?
38
Q

What is a good question to ask to get the Where?

A
  • Where did he touch you?

- Where were you when this happened?

39
Q

What is a good question to ask to get the How?

A
  • You said Uncle Joe touched your peepee. Did he touch you under your clothes or over your clothes?
40
Q

What are some very high risk populations for sexual abuse?

A
  • Intellectually disabled- 4x more likely
  • Deaf children - 50% are victims in childhood or adulthood
  • Among developmentally disabled adults (83% of females are victims and 32% of males)
  • LGBTQ - 3x more likely
  • Transgender - 50% are victims in childhood or adulthood
41
Q

What is the physician’s role in providing emotional support in sexual abuse?

A
  • Ensure safety
  • Provide empathy
  • Be nonjudgmental
  • Be gentle
  • Avoid re-traumatizing
42
Q

What is important to remember when reporting abuse?

A
  • Failure to report is a class A misdemeanor in missouri and a Class B misdemeanor (even when another has made a report because all mandated reporters must report)
43
Q

How many cases of elder abuse goes unreported?

A
  • 80%
44
Q

Who are the victims of elder abuse?

A
  • Those with dementia, psychiatric diagnosis
  • Physical dependence
  • Incontinence
  • Alcohol or other substance abuse
  • Poor health
  • > 75 years old and female
  • Low income
  • Does not report the abuse
  • History of domestic violence
45
Q

What are some characteristics of elder abuse perpetrators?

A
  • Substance abuse
  • Male
  • History of substance abuse or psychiatric problems
  • History of violence
  • Poverty and social isolation
  • Financial dependence on the victim
  • Often the closest caregiver or family member
46
Q

What are the five types of elder abuse?

A
  1. Physical: hitting, slapping, shaking, strike with object
  2. Sexual: rape, unwanted touching, innuendo
  3. Psychological: threaten to institutionalize or to withdraw RX, nutrition or hydration
  4. Financial: theft, blackmail, coercion to change will or other legal document that counter’s victims best interest
  5. Neglect: failure to provide goods/services necessary for maintaining health and avoiding harm/illness
47
Q

What is active neglect in elder abuse?

A
  • Refusal to provide basic needs of hygiene, food, RX, physical assistance as needed for safety
48
Q

What is passive neglect in elder abuse?

A
  • Due to ignorance or inability of caregiver
49
Q

What are the abuse signs with neglect?

A
  • Lack of needed nutrition
  • Poor personal care (urine odor in incontinent person)
  • Lack of needed medication or health aids (eyeglasses or dentures)
50
Q

What are the abuse signs with bruises?

A
  • Often bilateral and on the inner surface of the arms from being grabbed
  • Bruising of soft tissue which is not over bony prominences
51
Q

What are the abuse signs with burns

A
  • Cigarette burns

- Other forms of burns (e.g. food too hot, bath too hot)

52
Q

What are the abuse signs with fractures?

A
  • Fractures at different stages of healing

- Spiral fractures caused by twisting of limbs

53
Q

What are the other signs of abuse?

A
  • Internal abdominal injuries
  • Wrist rope burns caused by tying to chair or bed
  • Injuries to the mouth caused by forced feeding
  • Evidence of depleted personal finances
54
Q

What are some signs on the PE of elder abuse?

A
  • Poor physical care
  • Psychosocial distress
  • Bruising, burns
  • Cognitive decline
  • Injuries due to fall
  • Unexplained injuries
  • Findings of sexual abuse
  • Verbal report of abuse
55
Q

What is the physician’s role when suspecting elder abuse?

A
  • Report to senior protective services
  • Document carefully
  • Photographs if possible
  • X-ray as needed
  • Diagram of injuries
  • Written documentation
56
Q

What is the consequence of failing to report elder abuse?

A
  • Class A misdemeanor in missouri (1 year jail + $2000)

- Class B misdemeanor in Kansas (6 months jail + $1000)

NMSP Exam 3 (18 decks)

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