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Pediatrics > Child Maltreatment > Flashcards

Child Maltreatment Flashcards

1
Q

Abuse

A

Physical, sexual, or emotional injury inflicted upon a child by an adult

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2
Q

Neglect

A

failure of a caretaker to meet a child’s enviro, nutritional, or medical needs
- failure to provide for basic needs
- failure to provide adequate care
- act of ommission

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3
Q

Child at risk

A

lives in a setting known to inc likelihood of abuse or neglect

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4
Q

Pediatric abusive heat trauma

A

Injury that occurs when an infant or child receives deliberate direct blows to the head, is deliberately dropped or thrown, or is vigorously shaken

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5
Q

Child abuse prevention and treatment act (CAPTA)

A

Federal funding and guidance to states for abuse cases, grants to some organizations, provides a definition of abuse

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6
Q

Contributing factors in neglect

A
  • ignorance of needs
  • lack resources
  • poor parenting skills/edu
  • failure to recognize emo nurturing as an essential need of child
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7
Q

Consequences of global neglect

A
  • dev delay
  • neuro probs
  • poor socialization
  • parentification–kid has to act as parent (may have to happen with chronically ill parents)
  • multiple minor scarring injuries
  • death or serious injury during inappropriate supervision
  • high chance of dev personality dx assoc with criminal and abusive behaviors when combined with phys/sex abuse
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8
Q

Manifestations of neglect

A

Child
- freq absent
- beg or store food
- unhygenic and odorous
- poor clothing
- abuses alc or drugs
Parent
- appears indifferent to child
- seems apathetic or depressed
- behaves irrationally
- abusing alc or other drugs

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9
Q

Physical abuse (non-accidental trauma–NAT) family and enviro fx

A

Family
- already domestic violence
- single mom or SAHM
- poverty/limited resources
- unemployment
- single parent
- animal abuse
- inc exposure btwn parent and child
- fussy
Parental char
- sub abuse
- low self-esteem
- poor impulse control
- abused as a child
- teen parents
- neg view of child (remind of ex)
- depression
- unrealistic expectations of child’s behavior
- believe in corporal punishment

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10
Q

Risk factors for child

A
  • fussy/more challenging
  • hyperactive or perceived defiance to parent, temperament
  • cleft lip/palate
  • conditions that alter parent/child bonding
  • prolonged chronic illness
  • multiple births
  • dev delay
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11
Q

Warning signs of abuse

A
  • no injuries that are always or never caused by abuse
  • physical evidence
  • no hx to explain physical findings
  • injury inconsistent with hx or dev level
  • delay in seeking medical attn
  • hx change with repitition
  • parents blame child or sibling
  • seek medical attn far from home or in multiple places
  • reaction to injury is inappropriate
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12
Q

Behavioral char of abused kids

A
  • wary of adults
  • vacant stare or watchful
  • overly compliant, passive or w/d (esp with pain)
  • parentification
  • constantly tried to pls parent and assess parent rxn
  • doesn’t turn to parents for support
  • aggressive towards animals or small kids
  • sudden chx in behavior or school performance
  • learning prob (prob concentrating) not attributed to physical or psych causes
  • come to school early and stay late, don’t want to come home
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13
Q

Behavioral char of abusive parents

A
  • show little concern
  • deny existence of or blame child for school probs
  • ask teachers to use harsh phys discipline
  • sees child as worthless, bad
  • demands high level of phys or academia performance child can’t acheive
  • looks primarily to child for care attn, satisfaction of emo needs
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14
Q

Phys indicators of abuse

A
  • patterns of abuse
  • bruises, welts, lacerations, abrasions, broken bones
  • esp in various stages of healing
  • clustered lesions, forming regular pattern, teeth marks, handprint
  • shadow bruises–same shape as article used to injure
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15
Q

1 sign of abuse

A

Bruising, esp on buttocks, genitalia, back, inside of nose, thighs, calves

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16
Q

Rule of TEN–think abuse

A
  • Torso–lots cushion to absorb force
  • Ears–hard to bruise, not very vascular
  • Neck–protected and no structure to provide cushioning required for vascular damage/leaking
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17
Q

Mongolian spot vs bruise

A

Bluish color that does not fade/have different shades like a bruise would

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18
Q

Infancy patterns of abuse

A

More abuse than any other group
- fatal abuse, head trauma, abusive fractures, Munchausen’s, global neglect with FTT
- trigger is often crying
- can’t explain or defend self

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19
Q

Pediatric abusive head trauma (PAHT)

A
  • injury that occurs when an infant or child receives deliberate direct blows to the head, is deliberately dropped, or is shaken vigorously
  • matter of seconds from 3 violent shakes
  • includes shaken baby syndrome
  • most often 3-8M
  • fatality rate is 20%, significant disability in 2/3 kids
20
Q

Mechanism of injury from shaking

A
  • forceful shaking from more space in skull causes ruptured BVs and nerves, bruising brain tissue, bleeding and swelling
  • pressure on blood supply further exacerbates the brain injury
  • lack of blood supply to parts of the brain can cause long-term effects
21
Q

Why do kids’ heads put them at higher risk for damage?

A
  • thinner tissue
  • smaller subdural space and large subarachnoid space
  • greater volume of blood in brain
  • expandable skull
  • underdev cervical ligaments and muscles
22
Q

s/s of PAHT

A
  • unequal pupils
  • RETINAL HEMORRHAGE
  • sz or posturing
  • high pitch cry
  • pale, mottles, cold, clammy skin
  • poor feeding
  • bruising
  • vom
  • chx in LOC
  • dec in smiling or vocalizing
  • behavior chx
  • vision loss
  • chx in head control
  • bradypnea or apnea
  • bradycardia
  • bulging fontanelle
  • alopecia
  • fracture
  • scalp bruise
  • black eyes
23
Q

Perpetrator characteristics

A

Male, under 30, edu less than high school, illiterate, depression, social iso, sub abuse, low self esteem, poor impulse control

24
Q

Risk fx in child

A

Male, colic, premature, low birth wt, NAS, special needs, medically fragile, infants with NAS or cry freq, multiple births

25
Q

Fractures of abuse

A
  • most fractures under 1Y and under 3Y are from abuse
  • femur, humerus, tibia often; also skull, ulna, radius, fibula, nose, facial bones
  • frac in different stages of healing
  • scapular fracture in child w/o clear history of violent trauma
  • epiphyseal and metaphyseal fractures of the long bones
  • corner or chip fractures of the metaphyses
  • spiral fracture
26
Q

Abuse of toddlers

A
  • Triggers–toilet training probs, temper tantrums, perceived disobedience/disrespect
  • exacerbated by unrealistic expectations
27
Q

Burns; contact burns

A
  • soles of feet, palms, back or butt
  • pattern burns–irons, heater grates, cigs
  • look like something (like heater)
  • rope burns
28
Q

Accidental vs nonaccidental fluid or immersion burns

A
  • irreg shaped burn at point of major contact vs clear delineation from unburned areas
  • splash vs no splash marks
  • depth of burns dec dramatically as distance inc
  • flow marks proceed down from major burn region
29
Q

Abdominal injuries

A
  • irregular bruising
  • ruptured liver or spleen
  • pancreatic or kidney injury
  • intestinal perforation
  • check for bleeding signs
30
Q

Nurse’s role: prevention

A
  • educate caregivers
  • recognize triggers and risk fx
  • be a role model
  • hospital based programs
  • edu on period of purple crying (for all infants, crying increasingly more from 2W to 3-5M w/ resistance to soothing, most in evening, pain-like face and long lasting)
31
Q

Dr Harvey Karp’s five Ss

A
  • shushing
  • side/stomach positioning
  • sucking–nonnutritive
  • swaddling
  • swinging
32
Q

Other strategies for upset babies

A
  • check basic needs are met
  • check for signs of illness
  • rock or walk infant
  • sing or talk to baby
  • offer pacifier or noisy toy
  • stroller rise
  • hold baby close to body and breathe calmly and slowly
  • call for help
  • take 10 minute break
33
Q

nurse’s role: recognition and common mistakes

A
  • most physical abuse is missed in the acute care setting
  • non-sepcific s/s attributed to benign causes
  • subtle cues missed
  • parents are “nice people”
  • give the benefit of doubt to adult, not baby
34
Q

Common assumptions/bias

A
  • nice fam
  • nurse knws them
  • don’t want to cause fam stress
  • don’t want to expose baby to radiation for radial scan
  • person before you may have no idea of the abuse
35
Q

Recognition of PAHT

A

lethargy, irritable, poor feeding, sx, dec appetite, odd bruises or patterned, not smile and vocalize, posturing, poor breathing, can’t lift head, eyes not tracking

36
Q

Accident or PAHT assessment

A
  • make sure injury matches dev level of child
  • examine bruises carefully
  • does injury and age of child match?
  • is hx feasible?
  • social situation?
  • was it witnessed?
37
Q

Nurse’s role in child maltx

A
  • meet phys needs
  • role model for parent
  • very good notes bc may not remember details
  • document fully and objectively
  • REPORT–not our job to figure out all the details
38
Q

Guidelines for therapeutic inx in child maltx cases

A
  • be nonjudgmental
  • provide nonthreatening enviro
  • ask open ended questions
  • avoid unprofessional attitudes that block therapeutic intx
39
Q

Documentation of phys abuse

A
  • date, time, place of occurence
  • sequence of events with times
  • add direct quotes and time if you can
  • presence of witnesses
  • verbal quotations from parent and child
  • description of parent-child intx
  • name, age, and condition of other kids in home
  • location, size, shape or lesions
  • distinguishing char
  • symm vs asymm of injuries
  • tenderness with palpation
  • degree of pain, bone tenderness
  • dev of child, meeting milestones?
40
Q

Sexual abuse examples

A
  • genital exposure
  • fondling
  • sexual penetration
41
Q

Char of sexual abusers

A
  • male
  • well known to child
  • all social levels
  • often in positions where work closely wiht kids
  • abuse is reptitive
  • use coaxing and threats
42
Q

Char of sex abuse victims

A
  • little physical evidence esp in males
  • may be bruises, bleeding, irritation of external genitalia
  • torn, stained underclothes
  • pain on urination, swelling, itching, recurrent UTIs
  • STDs
  • difficulty walking or setting
  • SELDOM make up abuse
  • possess sexual knowledge beyond what is dec appopriate
  • behavioral chx–stress, anx, new sex curiosity, excessive masturbation in appropriate places, seductive behavior
43
Q

Nursing interventions in sexual abuse

A
  • always believe
  • provide play opportunities for disclosure
  • avoid leading statements
  • never promise not to tell
44
Q

Munchausen Syndrome by Proxy (MSP)

A

Illness that one person fabricates or induces in another person
- giving child med to induce vom
- feed child ketchup?

45
Q

Child and perpetrator char for MSP

A

Child
- under 6Y
- uncooperative
- anxious
- fearful
- negative
Perpetrator
- usually the mother
- thrives in HC enviro
- some HC knowledge
- loving, cooperative, competent
- suggest tests and procedures

46
Q

Common presentations of MSP

A
  • apnea–suffocation, drugs, poisoning
  • sz–drugs, poisoning, asphyxiation
  • bleeding–add blood to urine, vom, opening IV lines
  • inject products into child to give blood infx
  • poison with drugs that cause vom
47
Q

When to suspect MSP

A
  • unexplained recurrent or extremely rare illness
  • discrepancy btwn clinical findings and hx
  • unresponsive to tx, s/s occurring only in parents presence
  • knowledgeable parent who refuses to leave child’s room
  • parent very interested in interacting with medical staff
  • family mem with similar sx

Pediatrics (26 decks)

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