CYPT Flashcards
which is NOT RF for child maltreatment:
- poverty or single parent household
- parental substance abuse or mental health hx
- low SES
- parental domestic violence or child abuse
- corporal punishment or spanking
Corporal Punishment or Spanking
List 5 RF or child abuse:
> CHILD
- LD
- FTT
- Intellectual disability
- ADHD
- Prem or low BW
- unplanned preg or unwanted
> CAREGIVER
- victim if domestic violence
- few social supports
- substance abuse
- mental health (Depression)
- single or young
- low SES
- (-) perception of normal child behav
- caregiver hx abuse or neglect as child
> ENVIRN’T
- unrelated teen or adult male in house
- partner/ domestic violence
- animal cruelty
- family stressor
- poverty
- social isolation
Are 0-7 or 8-15 most likely to be sexually or physically abused?
0-7
Younger the child = more likely to be abused
List two child abuse protective factors:
- Family support
2. Maternal concern for child.
What is the rule of TEN?
Child < 4 with bruise in these areas= suspicious.
> TORSO (incld perineum and buttock)
> EAR
> NECK
What % of kids have child maltreatment?
2%
T or F: the most common cause of serious head injury in < 1 y.o. is child abuse.
True
What are post partum blues versus depression versus psychosis?
Blues:
- 1st week
- hr-days
- few (-) sequelae
Depression:
- last several month
- can have (-) sequelae
Psychosis:
- start w/in 4k of post part
- delusion, hallucination, f’n impact
List RF for maternal depression:
- Mood disorder dx
- Depression symp. during pregnancy
- FHX of psych dx
What are prenatal consequence of maternal depression?
- poor prenatal care
- poor nutrition
- pre eclampsia
- spontaneous abortion
- prem birth
- low BW
What are infant sequelae of maternal depression?
- insecure attachment
- anger or protective coping
- withdrawal
- (-) affect
- dysregulated attn
What are toddler sequelae of maternal depression?
- poor self control
- cognitive f’n difficulty
- difficulty w/ social interaction
- less creative play
What are school age kid sequelae of maternal depression?
- impaired adaptive *function
- affective dx (anxiety), CD, ADHD, LD
- lower IQ score
Teen sequelae of maternal depression?
*Depression Anxiety Phobia CD *Substance Abuse *ADHD LD
What are protective factors if mom has depression?
- non depressed father can ‘buffer’
- easy temperament
- good social skill
- understand parent’s illness
T or F: Risk of SSRI > in baby than benefit to mom in maternal depression.
False
T or F: St. John’s Wart safe to take during pregnancy and lactation.
False.
- data scarce on safety
Which pair cannot have legal consenting sex?
- 16 y.o. couple
- 16 y.o. + 22 y.o. teacher
- 12 + 13 y.o.
- 14 + 18 y.o.
- 13 + 15 y.o.
Age of consent: 16
*UNLESS authority, dependent on partner (i.e. they provide care) or exploitative
14-15: if < 5 yr older
12-13: if < 2 yr older
If not consented= criminal offence
what are bruising red flags?
/Shape:
Child:
- Non-Mobile
- < 9 mon.
Location:
- TEN
- Bruise away from bony prominence
- multiple in cluster or same shape
- Shape of object
- B/L or symmetrical
Bruise that does not fit mechanism
What are # red flags for abuse?
Child: Non-mobile
Location:
- Rib
- long-bone metaphyseal (CML)
- scapula
- sternum
- vertebral spinous process
#: - multiple at various healing stage
What are symptoms of abusive head trauma?
- lethargy
- poor feed
- irritable
- vomit
What is abusive head trauma?
Specific form of traumatic brain injury
Defined by symptom, sign, investigation
Consequence of violent shaking, impact or combo
T or F: you should consider abusive head trauma if rib, skill or metaphyseal #.
True
What is an abusive head trauma assessment:
- P/E
- Ophtho
- CBC + Coag
- Lytes, BG, metabolic, toxic
- skeletal survey +/- bone scan or repeat in 2 wk
- CT if acute; MRI if non acute
What should you do with siblings of kids with abusive head trauma?
P/E
Eye Exam
Neuro imaging
Skeletal Survey (even if normal exam)
List 3 mimic of bruising:
Slate grey nevi Hemangioma Stain from dye Striae Coining or cupping
What is first line investigation for bruising?
CBC + smear INR/ aPTT/ fibrinogen vWf studies Blood group Factor 8 and 9 levels LFT Renal Function
2nd line:
- factor 13, thrombin time, plt aggregation studies, homocysteine etc.