Childhood Maltreatment: Non-Accidental Trauma and Childhood Neglect

Question 1

neglect

Answer 1

Neglect: defined as a guardian being unwilling or unable to provide a child with any of the following:

• The necessities of life
• The provision of adequate care or supervision
• Essential medical, surgical or other treatment.

Question 2

risk factors to child abuse

Answer 2

Low SES, domestic violence, non-biological caregivers

Low education

Single parent

Unwarranted pregnancy

Mental illness

Personal history of abuse

Unrealistic expectations

Involvement in criminal activity

Young, non-verbal child

Behavioural and medical problems

Question 3

2. Identify red flags on history raising concern for abuse and/or neglect

Answer 3

History not compatible with injury, history of injury changes with time, caregiver blames serious injury to a younger sibling, playmate or pet

Child is described as “difficult”

Frequent visits to different health care providers for injury

Extensive physical injury with history of minor trauma

Evidence of injury with no history of trauma

Self-inflicted trauma that is incompatible with the child’s development

Question 4

Concerning History for Sexual Abuse

Answer 4

Sudden change in behaviour

Regressive behaviour

Difficulty sleeping

School difficulties

Sexually inappropriate behaviour

Child discloses sexual abuse\

Question 5

Physical Indicators of Neglect

Answer 5

Unattended medical or dental problems: infected sores, decaying teeth, needing eyeglasses

Underweight or dehydrated

Poor overall hygiene, emaciated or a distended stomach

Lacking clean or appropriate clothing suitable for weather or climate conditions

Question 6

key location of bruising that may indicate an intentional infliction

Answer 6

torso, genitals, and neck are unusual places to bruise

Question 7

most common physical exam findings in a child who has been sexually abused

Answer 7

The most common physical exam finding in a child who has been sexually abuse is that the exam is NORMAL!

Genital injuries heal very quickly

The hymen is flexible, particularly as a child enters puberty, and can be penetrated without any resulting injury

A child’s definition of penetration may be different than an adult

Question 8

T/F a hymen can be broken with tampons

Answer 8

Hymen: A mucous membrane that surrounds the opening of the vagina. All female children are born with a hymen.

• Is NOT a complete covering of the vagina that breaks with the first sexual intercourse.
• Also not “broken” by tampons, masturbation, horseback riding, etc.
• In reality the hymen is a circular (or semi-circular) membrane that ALWAYS has a central opening except in rare circumstances (imperforate hymen).

Question 9

General investigations for suspected child abuse:

Answer 9

other acute occult injuries, rule in/out medical conditions, old injuries

Investigations: CBC, INR/PTT, renal and liver function, Calcium, phosphate and vitamin D, skeletal survey, head CT/MRI, hematology consult, genetics consult, ophthalmology consult

Look for old injuries during skeletal survey and head CT/MRI

Question 10

T/F you have to tell the family you are going to report them to CPS

Answer 10

false.

• You are protected against litigation if you report possible child abuse that is later deemed not to be.
• You are liable if you suspect or should have suspected child abuse and did not report it.
• You can notify the family of your report to child welfare if you choose to but you ARE NOT required to notify them.

Question 12

Abused children are at risk for developing problems in the following areas:

Answer 12

• Emotional and behavioural regulation
• Attachment
• Cognitive development
• Language development
• Adjustment to school
• Peer relationships

Question 13

• Post-Traumatic Stress symptoms:

Answer 13

• Post-Traumatic Stress symptoms:

– Hyperarousal

– Re-experiencing

– Avoidance

– Shame, guilt, confusion regarding the abuse