Child Maltreatment Flashcards
If concern for abuse but skeletal survey is negative, what should you do?
Follow-up with repeat SS in 2 weeks
Are humeral fractures ever suspicious for child maltreatment?
Children <18 months of age
When would you be even more concerned for abuse with condyloma acuminatum?
Child >5 years of age
Genital exam findings that are concerning for abuse
- Acute trauma: laceration/bruising to labia/penis/perineum, laceration of posterior fourchette, bruising/petechiae/abrasions of hymen, acute laceration of hymen, vaginal laceration, peri-anal laceration
- Resident injuries: peri-anal scar, scar of posterior fourchette, healed hymenal transection/complete hymen cleft (below 3-9 o’clock position), signs of FGM/cutting
x6 red flags for bruising in children
- Non-mobile child
- Patterned
- Bilateral or symmetrical
- Location
- Extensive/large/numerous
- Do not fit mechanism
Unusual locations for bruising in children
- Buttocks
- Genitals
- Back
- Ear
- Neck
- Chest
- Abdo
- Feet
First line investigations for bruising
- CBC
- Renal fxn, LFTs
- PTT/INR, fibrinogen
- Factor VIII and IX
- vWD + blood group
Risk factors for abuse in fractures
- Non-mobile child
- No history of trauma
- Incompatible mechanism
- Multiple fractures
- Fractures of different stages of healing
- Location
Concerning locations of fractures for abuse
- Humerus for <18 month child
- Femur in non-mobile child
- Scapula
- Sternum
- Ribs
- Vertebral bodies
- Long bone metaphyses
DDx for fractures
- Trauma: birth, accidental, non-accidental
- Genetic: osteogenesis imperfecta, menkes disease, hypoPO4, infantile cortical hyperostosis
- Nutritional/metabolic: Vit D deficiency rickets, osteopenia of prematurity, copper deficiency, chronic renal insufficiency, scurvy
- Infection: OM, congenital syphilis
- Toxicity: hypervitaminosis A, MTX toxicity
- Neoplastic: leukemia, langerhans cell histiocytosis
Indications (x3) for skeletal survey
- Any child <24 months of age if concerns for abuse
- Younger sibling if severe injuries in older sibling
- Consider in older children with GM delay
DDx for subdural hemorrhage
- Benign enlargement of subarachnoid space
- ID: meningitis
- Neoplastic: tumor, leukemia
- Coagulopathy: vwF, factor def, platelet disorder, fibrinogen disorder, vitamin K deficiency
- Structural: AVM, aneurysm
- Trauma: inflicted, accidental, birth
- Genetic/metabolic
Most common type of intracranial finding in abuse
Subdural hemorrhage
When should you consider screening for an occult head injury in asymptomatic children?
CT/MRI in children <6 months of age with any suspicion for physical abuse
When is it not worth an optho exam in a case of abuse?
- neuro normal
- head imaging normal
