Child Maltreatment

Question 1

What is the greatest risk factor for child maltreatment in Canada?

Answer 1

Caregiver is a victim of intimate partner violence

Question 2

Adults who have been exposed to abuse as children are at increased risk for?

Answer 2

• depression
• biopolar
• suicidal ideation
• eating disorders
• drug/substance abuse
• any mental disorder

Question 3

What are the laws regarding consent for sexual activity?

Answer 3

• Age of consent in Canada is 16
• Child must be 18 yrs in cases of exploitative (pornography) or with individuals in position of authority

Close-in-age exceptions

• 14 or 15 yr olds can consent to sexual activity with a partner less than 5 yrs older
• 12 or 13 yr olds can consent to sexual activity with a partner less than 2 yrs older

Question 4

If a child discloses a long-standing sexual abuse with genital to genital contact what should you ask during your history taking?

Answer 4

Ask if she is currently experiencing any symptoms

Major interest is any medical concerns as you do not know how to do forensic interviewing

Question 5

What are the bruising red flags (6)

Answer 5

• Non mobile child (no cruising no bruising)

Mobile children:

• patterned bruises
• bilateral/symmetrical bruises
• bruises that are unusually large or numerous
• bruises that do not fit the mechanism described
• location

Question 6

What are areas of suspicious bruising in mobile children

Answer 6

• ears
• genitals
• buttocks
• feet

Question 7

What are fracture red flags

Answer 7

• fractures in non-mobile children
• multiple fractures
• fractures in different stages of healing
• location: higher specificity
• ribs
• long-bone metaphases (CMLs)
• scapula
• sternum
• vertebral spinous process

Question 8

For work up of NAT what should you order

Answer 8

• Bleeding work up (CBC, coags, vWF screen)
• Skeletal survey
• Optho consult
• CT head (if suspicious of head injury)
• AST, ALT, lipase (significant if lipase > 3 x ULN or AS/ALT > 80)

cranial and abdo u/s not sensitive enough - would need a CT

Question 9

What is included in a differential for an infant with a subdural hemorrhage

Answer 9

• benign enlargement of the subarachnoid space (aka benign extra-axial fluid of infancy)
• coagulopathy: vWF disease, factor deficiencies (VII, IX, XIII) plt problems, fibrinogen disorders, vit K deficiency
• birth trauma
• accidental injury/non accidental injury
• structural causes: AVM, aneurysms
• neoplastic diseases: brain tumor, leukemia
• infectious: meningitis
• genetic/metabolic: menkes disease (x-linked diseases with SDH), glutamic aciduria type 1

Question 10

What are Sentinel Injuries

Answer 10

• minor injury that is externally visible to caregivers or health care providers
• most commonly bruises (80%) or intra-oral injuries (10%)
• multiple studies show 20 - 30% of children with serious inflicted injuries (fractures or head injury) in retrospect has previously unrecognized sentinel injuries