Child Maltreatment Flashcards
Types of child abuse*
Neglect
Physical abuse
Sexual abuse
Emotional abuse (psychological maltreatment)
What type of child maltreatment goes unreported
Sexual abuse
Which type of child maltreatment is hard to prove
Emotional abuse
Signs of child abuse / neglect
Changes in behavior
Changes in school performances
And attendance
Unexplained injuries
Changes in eating
Changes in sleeping
Lack of personal care or hygiene
Comes to school early stays late , doesn’t want to go home
Risk taking behavior
Fear of certain places, people
Returning to earlier behaviors (regression))
Inappropriate sexual behaviors
What does stress cause?
Regression
Types of child maltreatment
Physical neglect
Emotional abuse/neglect
Physical abuse
Sexual abuse
Physical neglect
Deprivations of necessities
Food , clothing, shelter, supervision, medical care, education
Common form
What is another contributing factor to physical neglect
May be due to a lack of knowledge of the child’s needs, lack of resources,and caregiver substance abuse
Emotional maltreatment
Emotional neglect
Emotional abuse
Emotional needs
Failure to meet the needs of affection, attention and emotional nurturance
Emotional abuse
Deliberate attempts to destroy or significantly impair a child’s self esteem or competence
Forms of emotional abuse
Rejecting the child
Isolating
Terrozing(bleach ex)
Ignoring
Verbally assaulting
Overly pressuring the child
Physical abuse
The deliberate infliction of physical injury on a child usually by the child’s caregiver
Rule of thumb for spanking
Only use hand, no objects
And only on the seat of the pants (buttocks area) with clothes on
Injuries from abuse
Bruises
Bites
Burns
Lacerations
Pinch mark
Swelling
Tenderness
What can injuries occur from?
Punching, beating, shaking, kicking, biting , throwing , burning
Sexual abuse
Persuading any child to engage in or assisting another person to engage in sexual conduct or simulation of such conduct
Typical abusers
Male victims knows (can be however including women and siblings)
Father
Step father
Relatives
Physical signs and symptoms of sexual abuse
Injury to external genitalia, anus mouth and throat
Painful urination
Recurrent UTI
Constipation or stool incontinence
STI
Difficulty walking or sitting
Pregnancy
Emotional psychological s/s of sexual abuse
Sexual comments, behaviors or play
Regressive behavior -bedwetting
Personality change (withdrawn)
May resist in removing clothes for exam
Phobias (dark, strangers, leaving the house)
Reports nightmares
Sudden change in apetite
Contributing factors for child maltreatment
Child
Parent environmental
Exact cause unknown
Interaction of these factors is thought to increase the risk of abuse occurring in a particular family
Characteristics of child (contributing )
Temperament (difficult)
Ordinal position (birth order)
Age-
Prematurity ,
behavioral disorder ,
unwanted pregnancy
, cognitive impairment,
hyperactivity
physical disability or chronic illness
What ages are at higher risk for abuse
Birth to 1 year . Birth to 2 yr makes up about 25% of cases
Difficult developmental stages that contribute to maltreatment
Colic
Potty training
Teenagers
Even though its typical in families to have one child that is abused what happens when CPS decides the home is unsafe
Removes all of the children in the home
Parental characteristics contributing factors
History of abuse/neglect”parent imprint”
Difficulty controlling aggression
Substance abuse
Inadequate support systems
One abuser while other parent permits it
Younger parents
Socially isolated
Marital probs
Substance abuse
Makes up 40% of child abuse cases
What is it that we ccan provide to younger parents
Anticipatory guidance
Teaching about normal growth and development ( at pedis office or clinical at well checks)
Important parental characteristic of contributing factors of maltreatments
Inadequate knowledge of appropiate parenting skills / inappropiate or unrealistic expectations for child’s developmental
( getting mad for potty training a 8 mo old)
Enviromental contributing factors to abuse
Chronic stress
Poverty
Unemployment
Poor housing /crowded living conditions
Frequent relocations
Divorce
Day care providers, baby sitters ( not guy evaluated)
Assessment findings indicators
Inconsistent with injury
Incompatible with the child’s development
Delay in seeking medical treatment
History changes repetition (asking over and over again)
Contradictory histories
Non-accidental injuries (loop marks)
Types of injuries
Skin or soft tissue injuries
Musculoskeletal injuries/fracture
Abdominal injuries
Head injuries
Skin or soft tissue injuries
Bruises bites burns lacerations
most common manifestation of physical abuse
Bruises
How many do they have?
Color- tells if they all happen at the same time
Accidental bruises how can we tell ?
Locations (boney prominences)
Shines, lower areas
Under the chin forehead
Appearance - minor or small
Non accidental bruises
Upper arms
Trunk
Upper anterior les
Sides of face
Ears and back
Genitalia and buttocks
At what ages should you not see bruising
Less than 4 mo of age
Those who don’t cruise rarely bruises
How many bruises is considered suspicious
4-5 unless they had a big accident like on a 4wheeler which wouldn’t be a surprise
Patterned bruises
Grab marks- finger tip
Slap marks / handprints
Pinch marks which are often in occult areas, e hind ears on genitalia
Loop marks instrumental
Symmetrical bruises
bruises that are on both sides of the body ( both upper arms )
Binding bruises
Result from being tied with an object such as an electrical cord , rope , belt , etc
Bite marks adult canine to canine distance
> 3cm between the two Dracula teeth)
Burns
Time of immersion and water temp
How long was child in it?
Recommended to lower the water heater to
120f
Accidental patterns
Splash burns (anterior surfaces, tapering (water running down) )
Objects burns (palms, soles, forearms)
Non accidental patterns for burns
Forced immersion burns
Extremity immersion (glove like) (sock like)
Trunk Emerson (donut)
Pattern object burns
Irons
Curling irons
Cigarette burns
Suspicious lacerations
Frenulum of upper lip
Rectal area
Vaginal area
Suspicious skeletal fractures
May be single or multiple
New or old or combination
Femur
Rib(especially bilateral0
Scapular
Sternal
Skill
Humerus
When is a femur fracture suspicious
Children less than 1 yr
When is a humerus fracture suspicious
Less than 3 y of age
Types of fractures (suspicious )
Spiral fractures
Metaphysical fractures
Spiral fractures
Twisting/pulling
Metaphysical fractures
Twisting/pulling/yanking
Corner/bucket handle fractures
Twisting injury o=w consequent seperation of the corner piece of the metaphysics from the remainder of the bone
Caused by grabbing , twist or shake of a child’s limb in frustration
Abdominal injuries
2nd most common cause of death
Secondary to a blow
Rarely see Bruises (may or may not)
Ruptured liver, spleen , bladder, intestinal perforation , pancreatic injuries)
Suspicious abdominal injuries
Injury inconsistent w history
Delay in seeking care
Head injuries external
Ear boxing , periorbital injuries, traumatic alopecia (hair pulled out)
Other head injuries
Subdural /sub arachnoid hemorrhages
Retinal hemorrhages
Abusive head trauma / shaken baby syndrome
Caused by violent shaking of infants and young children
Also called inflicted head injury
Neuro inflicted brain injury
S/s of shaken baby syndrome
Poor feeding
Vomitting
Irritability
Listlessness
Seizures
Posturing
Apnea
Bradycardia
Alterations in LOC
Characteristics detailed injuries of abusive head trauma
Intracranial bleeding (subdural , sub arachnoid hematomas)
Bilateral retinal hemorrhages (80% of cases)
May also include fractures of the rubs and long bones
Most often there are no signs of external injury
Common triggers for Shaking
Crying
Maternal stress or depression
What can you do to reduce abuse related to theses triggers?
Anticipatory guidance about how to care for infants with inconsolable crying
Purple crying
Peak pattern
Unpredictable
Resistant to sooting
Pain like look on face
Long bouts of crying
Evening crying
Peak pattern of crying
Peaks around 2 mo then decreases
Unpredictable crying
Crying for long periods can come and go for no reason
Resistant to soothing
The baby may keep crying for long periods
Pain in purple
Pain like look in face
Long in purple
Long bouts of crying - crying can go for hours
Evening crying -purple
Baby cries more in the afternoon and evening
Münchausen syndrome by proxy (PSBP) or medical child abuse or fictitious disorder by proxy
The caregiver usually the mother with some degree of health care knowledge and training deliberately exaggerates or fabricates histories and symptoms or induce symptoms . The caregiver is often very attentive to the child and may refuse to leave them
Example of MSPB
May give drugs to poison child
May suffocate them to cause seizures
May give large doses of laxatives to cause diarrhea
Mothers have been know to inject feces or lighter fluid in their child’s IV lines
Cultural practices
Cupping- pain or healing
Coining- linear bruising- healing
Congenital anomalies of genitalia
May look like possible penetration of vagina but is not. Born that way
Erythema multi form or phytophotodrmatitis
May look like burns but are not
Idiopathic thrombocytopenia purpora (ITP) or hemophilia
Bruise like but not
Leukemia
Due to bleeding you can see bruising not abuse
Trauma focused cognitive behavioral therapy CBT
Helps a child who has been abused to better manage distressing feelings and to deal w trauma related memories
Child parent psychotherapy
Focuses on improving the parent child relationship and and on building a stronger attachment between the two
If you suspect abuse
Document history
Document physical findings
Drawings and photo doc
Report to cps
Consider hospital admission for child’s safety
Reporting
Mandatory reporting in good faith
Within 48 hrs
What is the priority when reporting
To remove the child from the abusive situation to prevent further injury
How do you report
Texas abuse neglect hotline
Can be confidential but do have to identify you to district attorney or law enforcement if case requires further investigation
Info when reporting
Name age address of child
Your name contact info
Description of situation
Childs current condition
Any info that will help identify or locate the child
Resources
Us dept of hhs
Children’s bureau
The period of purple crying
Local agencies
Children’s advocacy center
Casa of the south plains
Parenting cottage
Voice of hope
