Exam 2: Child Abuse

Question 1

What are the types of neglect?

Answer 1

1. Physical Neglect

2. Emotional Neglect

Question 2

Physical Neglect

Answer 2

• Deprivation of necessities

- For example, shelter, clothing, food, supervision, medical care, education.

Question 3

Emotional Neglect

Answer 3

Lack of affection, attention and emotional nurturance.

Question 4

What are the types of abuse?

Answer 4

1. Physical Abuse: deliberate infliction of physical injury on a child
2. Sexual Abuse
3. Emotional Abuse: to destroy or impair child’s self-esteem

Question 5

Abusive Head Trauma (Shaken Baby Syndrome)

Answer 5

• Violent Shaking
• Whiplash-induced bleeding
• Intracranial bleeding (subdural and subarachnoid)
• Rib fractures
• Long bone fractures
• Most often no external signs
• Not an isolated event

Question 6

Munchausen Syndrome by Proxy

Answer 6

• Caregiver deliberately fabricates signs and symptoms of an illness to gain attention of medical staff
• Child may undergo painful and needless procedures and treatments
• Perpetrator may have some degree of medical knowledge
• Index supervision of an adult (child displays no symptoms and may appear healthy and normal)

Question 7

What are predisposing factors to abuse?

Answer 7

1. Parental Characteristics
2. Child Characteristics
3. Environmental Characteristics

Question 8

Predisposing Factors to Abuse: Parental Characteristics include

Answer 8

• Young
• Single-parent
• Social isolation
• Little education
• Few supportive relationships
• Low self-esteem
• Little knowledge of parenting skills

Question 9

Predisposing Factors to Abuse: Child Characteristics include

Answer 9

• Birth to 1 year
• Disabled
• Premature infants

Question 10

Predisposing Factors to Abuse: Environmental Characteristics include

Answer 10

Chronic stress:

• Divorce
• Poverty
• Unemployment
• Crowded living conditions
• Frequent relocation

Question 11

What are warning signs of abuse?

Answer 11

• Physical evidence
• History is incompatible with the pattern and/or degree of injury
• Vague explanation
• Contradictory histories among caregivers
• Injury not possible due to age or developmental level
• Injury present in non-mobile child
• Inappropriate affect
• Multiple fractures in different healing stages
• Delay in seeking care

Question 12

Misinterpretations of Child Abuse include

Answer 12

• Bleeding Disorders
• Osteogenesis Imperfecta
• Sudden Infant Death Syndrome
• Cultural Practices: cupping and coin rubbing
• Unintentional Injuries: seat belt injuries and twist/fall injuries

Question 13

Child Abuse Assessment

Answer 13

• Identify abusive situations as early as possible
• Detailed history: from all involved
• Assessment of all aspects of the body including areas that are usually covered: past injuries
• Listen to what the child is saying/or not saying: Children express feeling primarily through behavior; a sudden change in behavior or response is a warning sign

Question 14

Child Abuse: Assessment Findings

Answer 14

• May be no physical findings
• Old bruising or fractures: Multiple stages of healing; older children - long bones, infant - ribs.
• Look in unexpected areas: begins ears, scalp, groin, thighs and abdomen
• Ask about behavior changes

Question 15

Management of Child Abuse

Answer 15

• Nurses are mandatory reporters
• Teaching is the best way to prevent abuse
• Priority is always to get the child to a safe place