Lecture 2 - Psychosocial Flashcards
What is the most common underlying cause of failure to thrive?
Psychosocial
What is the definition of failure to thrive?
Physical sign that the child is receiving inadequate nutrition for optimal growth and development
Marasmus vs Kwashiorkor
Marasmus is protein deficiency secondary to not eating enough
Kwashiorkor is consuming enough calories but not enough protein intake —edema, liver enlargement
Sentinel injuries
Warning signs for potential abuse
Bruising in non normal areas (face and head are huge warning signs
Who is at the highest rate of maltreatment?
Children <1 year of age
Low parental age Mental health disorders Substance abuse Domestic violence Low socioeconomic status
When should your level of concern be increased in regards to child abuse?
Lack or or changing history
History inconsistent with developmental stage
History inconsistent with type or severity of injury
Inappropriate delay in seeking care
Ex: if they say the 1 month old rolled off the changing table, you know that is unlikely since they don’t roll til 4 months
Occult injury surveillance
Head CT in children less than 6 months and those with abnormal neuro findings
Repeat skeletal survey 2 weeks later
Get dilated ophthalmolgic exam when abusive head trauma suspected
FRAMER
Way to tell the family in a non-judgmental style that you’re reporting for suspected abuse
F - give parents a listing of the FACTS that have led to your concern (avoid accusation, tell the truth)
R - explain that you are Required to Report your concern to child protection authorities on behalf of the child (no against the parents)
A - state the a form Assessment is needed to determine the exact nature of the problem and need for treatment
M - present the MENU of alternatives for evaluation and treatment services (team approach)
E - EMPATHY. Acknowledge how difficult a process this is for everyone
R - insist that you receive a REPORT back from the assessment and have open communication with the child protection worker
FDP
Factitious disorders by proxy
Formerly manchausen by proxy
What are common FDP symptoms?
Factitious disorders by proxy Bleeding Seizures Apnea GI sxs Skin sxs Sepsis Fever GU sxs
How do parents with FDP typically present?
Mother/female caregiver >90%
Highly attentive; reluctant to leave child’s side
Unusually calm despite serious concerns OR very demanding/angry seeking to escalate work up
What is the treatment of FDP?
This is child abuse - report it
What areas of the body can NOT be missed when assessing a child for potential abuse?
Labial and sublingual frenula Ears Scalp Anogenital Hands/Feet
