Child Maltreatment

Question 1

Types of abuse

Answer 1

physical
sexual
neglect
emotional
exposure to IPV/domestic abuse

Question 2

Physical & Sexual Abuse Hx

Answer 2

• interview each person alone
• open ended questions
• events, who, response
• child development
• other children around
• medical hx: bruising/bleeding disorder, etc

Question 3

Physical Examination

Answer 3

• bruises: non-boney areas, face, ears, abdomen, genitalia, buttocks
• neuro exam: fontanelle, head circumference, fundi
• mouth: frenulum
• abdomen
• MSK: swelling, pain/avoid moving limb
• GU: select cases, specialized team should perform

Question 4

Investigations

Answer 4

For injuries + ddx

non-ambulatory kids /w non-accidental injury:

• skeletal survey (all kids <2 /w ?NAI)
• MRI/CT head (all infants)
• opthalmoscopy - retinal hemorrhage if head injury
• labs: occult abdo trauma (AST, ALT, lipase)

if fractures:

• Ca, Mg, P, ALP, PTH
• vit D, renal function
• possibly: copper, ceruloplasm, syphilis

if bleed/bruising:

• CBC, INR, PTT
• VonW, ristocetin cofactor, blood type,
• factors 7, 9, 10, 13
• if intracranial bleed: carnitine + urine organic acids

sexual abuse: STI testing based on timeline/RF/contact

Question 5

Red Flags for abuse

Answer 5

• bruise in non-ambulatory
• bruise in cushioned areas
• patterned bruises
• fractures in <18mo
• fractures in non-ambulatory
• metaphyseal corner (<2 yr), rib, scapula, vertebral, sternum fractures
• many #s, different stages
• delay in seeking treatment

Question 6

abuse management

Answer 6

• treat acute issues
• contact CAS
• document everything thoroughly in patient’s own words / objective language

Question 7

Neglect defintion / examples

Answer 7

• not providing food, clothing, shelter
• not seeking med care
• failure to protect from violence
• allowing to miss ++ school