Class 7

Question 1

Evaluate if presence of abuse

Answer 1

The first step is to obtain a thorough familial psychosocial history. Draw a family tree and indicate who lives in the home with the child and in the home where the child visits (as in a separated/divorced family). Note maternal and paternal age at the time of the birth of their first child. Screen for psychosocial risk factors such as parental mental health/mental retardation, parental substance abuse, exposure to domestic violence, previous familial involvement with child protective services, parental involvement with law enforcement, parental history of child maltreatment as a child, and parental support systems, SES, attachment dynamics, type of discipline, 5 word that would describe mom and dad, what do you like to do with mom, life events that may have affected the child, who care for the child. A psychosocial history should be obtained at the child’s initial health care visit and updated annually. Recognizing that domestic violence is a pediatric health care problem, parents should be asked a few screening questions Screening questions should be asked at the initial patient visit, annually, or whenever a parent or teen presents with an injury that raises the concern for domestic violence or teen dating violence.

Question 2

Aspect of good resilience:

Answer 2

optimistic, use of humor, spirituality, cognitive flexibility, good self esteem, social support

Question 3

childhood determinants for future development of psychiatric illness

Answer 3

Exposure to emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, domestic violence, household substance abuse, household mental illness, parental separation or divorce, and a criminal household member, attachment. Number of ACEs, chronicity, severity (dose response relationship). Impact on neuroendocrine, immune function, cellular level, brain development.

Question 4

Impact of ACE on future

Answer 4

failure to thrive, anxiety, PTSD, mood, low self-esteem, dissociative disorder, cardiovascular disease, COPD, cancer, autoimmune disease, being a perpetrator himself, impulse control issues, antisocial behaviors, conduct disorder, SUD

Question 5

More at risk for maltreatment

Answer 5

Verbal vs non verbal, young age, child with special needs, children with behavioral difficulties

Question 6

Physical issues of a child who’s been neglected

Answer 6

fungal infections, fractures, under or overweight, dental decay, no immunization, lice, scabies, eczema, old scarring, bruising (patterns of fingers/ hands, parts of body that aren’t exposed), hygiene