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Child maltreatment Flashcards

1
Q

Features of osteogenesis imperfecta (10)

A

Bone features
- Excess or atypical fractures
- Scoliosis
- Basilar skull deformities – may cause nerve compression or other neuro symptoms
- Wormian bones = small, irregular bones along cranial sutures
- Opalescent teeth that wear quickly (dentinogenesis imperfecta)
Other features:
- Blue sclerae
- Hearing loss (usually in later childhood to early adulthood
- Short stature
- Increased laxity of the ligaments and skin
- Easy bruisability

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2
Q

Infections caused by sexual contact if vertical transmission is ruled out

A
  • neisseria gonorrhea
  • syphilis
  • chlamydia trachomatis
  • trichomonas vaginalis
  • HIV (if blood borne transmission ruled out)
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3
Q

Greatest risk factor for child maltreatment in Canada

A
  • caregiver is a victim of intimate partner violence
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4
Q

Adults exposed to abuse as children are at increased risk for…

A
  1. depression
  2. bipolar
  3. suicidal ideation
  4. eating disorders
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5
Q

Physical punishment puts children at risk for…

A
  • physical injury,
  • poorer mental health,
  • impaired relationships with parents,
  • weaker internalization of moral values,
  • antisocial behaviour
  • poorer adult adjustment
  • tolerance of violence in adulthood
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6
Q

Normal hymenal variants

A
  • annular
  • crescentic
  • imperforate
  • any notch above 3-9 o’clock
  • a notch or cleft below 3-9 that does not extend to the base
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7
Q

Abnormal sexual behaviours in children 2-6 yrs

A
  1. running body against others
  2. trying to insert tongue in mouth while kissing
  3. touching peer/adult genitals
  4. mimicking of movements associated with sexual acts
  5. sexual behaviours that are disruptive to others
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8
Q

Normal sexual behaviours 2-6yrs

A
  1. touching/masturbating in public/private
  2. viewing/touching peer or new sibling genitals
  3. showing genitals to peers
  4. sitting/standing to close
  5. trying to view nudity
  6. transient, few and distractable behaviours
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9
Q

Bruising red flags - mobile children

A
  1. patterned
  2. bilateral/symmetrical
  3. unusually large or numerous
  4. that do not fit the mechanism
  5. location: ears, neck, chest, abdomen, back, genitals, buttocks, feet
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10
Q

Bruising red flags - nonmobile children

A

any bruises!

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11
Q

1st line lab testing for bruises

A
  • CBC+diff, INR, PTT, fibrinogen, VWF studies, factor VIII, IX, LFTs, renal function tests
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12
Q

Fracture red flags on history (4)

A
  • incompatible with age/ developmental stage or injury
  • no hx of trauma or unwitnessed
  • hx changes with repetition
  • delay in seeking medical attention
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13
Q

Fracture red flags locations

A
  • ribs
  • long bone metaphases
  • scapula
  • sternum
  • vertebral spinous processes
  • humerus in < 18 mo
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14
Q

Skeletal survey indication

A
  • child < 24 mo in suspected abuse or severe neglect
  • younger siblings with severe injuries in older children
    (consider in older child with GM delay)
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15
Q

Benign extra-axial fluid of infancy

A
  • rarely symptomatic
  • small, usually anterior subdural hemohrrages
  • typically found when infants present with rapid head growth
  • healthy and developing normally
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16
Q

Screening for occult injury

A
  • skeletal survey < 24 months (well established guideline)
  • head imaging in chidlren < 6 months (some say < 12 mo)
  • ophtho not normal if normal neuro and normal head imaging
  • if severe injuries, AST, ALT and lipase to screen for intrabdominal injury (CT if symptomatic or if BW abnormal)
17
Q

Red flags for fractures

not the specific locations

A
  • age < 1 yr
  • high risk fracture
  • multiple fractures
  • fractures of different ages
  • presence of other injuries
18
Q

DDX skeletal injury - genetics

A
  • osteogenesis imperfecta
  • menkes disease
  • infantile cortical hyperostosis (Caffe’s disease)
  • hypophosphatasia
19
Q

DDx skeletal injury - metabolic/nutritional (6)

A
  • vit D deficiency
  • Rickets
  • osteopenia of prematurity
  • copper deficiency
  • chronic renal insufficiency
  • scurvy
20
Q

DDX skeletal injury - toxicity and infection

A
  • hypervitaminosis A
  • MTX toxicity
  • osteomyelitis
  • congenital syphilis
21
Q

Lab eval for fracture

A
  • CBC
  • renal and liver function tests
  • Ca, PO4, ALP
  • urinalysis
    Other: PTH, 25-OH vit D, serum copper and ceruloplasmin
22
Q

Labs for abusive head trauma

A
  • CBC with platelets

- coagulation profile

23
Q

Ages of consent for sexual activity

A
  1. Youth 12 or 13 can consent to sexual activity if partner is < 2 yrs older
  2. Youth 14 or 15 can consent if partner is < 5 yrs older
24
Q

Urgent assessment for pre-pubertal children who have experienced sexual abuse if…

A
  • within the past 72 hrs
25
Q

Diagnosis of sexual contact

A
  • pregnancy

- semen taken directly from a child’s body

26
Q

Indications for HIV PEP

A
  • suspected offender is HIV+
  • significant exposure
  • contact within 72hrs
    (follow up testing at 6, 12 and 24 weeks)
27
Q

Psychosocial support for child of sexual abuse

A
  • trauma-focused CBT
28
Q

Sentinel injury for future harm

A

Bruise!

29
Q

Most common inherited coagulation disorder

A
  1. von Willebrand disease

2. Factor VIII deficiency (hemophilia A)

30
Q

Lab eval for bruising

A

CBC, blood smear, PT/INR, APTT, fibrinogen, von willebrand studies (blood group for interpretation of von willebrand) Factor 8, Factor 9, LFTs (for secondary platelet f dysfunction), renal function (for secondary platelet dysfunction

31
Q

2nd tier heme testing

A
  • additional factor levels
  • thrombin time,
  • platelet disorder testing (aggregation studies of function testing)
32
Q

Potential outcomes of child death review

A
  • trend recognition in cases of fatality
  • CDR team can formulate recommendation to report on and modify RFs at different levels
  • lessons learned in injury, maltreatment and death prevention
  • policy changes
33
Q

Examples of recommendations from death review in Canada

A
  • sleep advocacy
  • youth suicide prevention initiatives
  • safer operation of motor vehicles
34
Q

Signs of inflicted burn (8)

A
  • clear delineation between burned and healthy skin and uniform depth
  • may have a sock or glove distribution
  • symmetric
  • burns of buttock and perineum
  • splash marks usually absent
  • patterns
  • deep and extensive reflecting more than fleeting contact
  • cigarette burns 7-10mm across

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