Module 6: Child Sexual Abuse

Question 1

Sexual Abuse Perpetrators Info

Answer 1

1. Perpetrators are ALMOST ALWAYS known by the child and family
2. Men are offencers 94% of the time in child sexual abuse

Question 2

Responding to Sexual Abuse Disclosure

-DON”T

Answer 2

1. Don’t promise NOT to tell
2. Don’t react with shock or disgust
3. Don’t criticize the abuse
4. DON”T question children - Be very careful - Ask open ended questions like “tell me what happened”

Question 3

Responding to a Child’s Disclosure

-DO’S

Answer 3

1. Do listen
2. Do reinforce that telling was right
3. Do document the conversation
4. Do take action
5. Do tell the child this was not their fault

Question 4

Behavioral Signs in Sexual Abuse

Answer 4

1. There is NO pattern of behaviorla sx’s specific to sexual abuse
2. 20-30% of children who have been sexually abused exhibit NO behavioral or emotional problems

Question 5

Most reliable indicator of Child sexual abuse?

Answer 5

1. The child said that it happened **

Question 6

Lichen Sclerosis Et Atrophicus

Answer 6

1. Chronic inflammatory dermatosis causing white plaques w/ epidermal atrophy
   - Can mimic sexual abuse/asault

Question 7

STD’s and Sexual Abuse

Answer 7

ALWAYS sexually transmitted

1. Gonorrhea
2. Chlamydia
3. Syphilis
4. HIV
5. Trichomonas vaginalis

Suspicious
-HPV, HSV

Question 8

HPV/HSV transmission

Answer 8

1. Vertical/Maternal
2. Skin to skin — Non-sexual or sexual
3. Autoinoculation

Question 9

Wrapping Up

Answer 9

1. Exam is almost always “normal”
2. Know the experts
3. Kids who have been abused act like KIDS
4. Most kids do not dislose right away
5. If you have a concern: REPORT

Question 10

Most common Types of Child Abuse

Answer 10

1. Neglect 75%
2. Physical abuse 18%
3. Sexual Abuse 9%

Question 11

Risk Factors for Physical abuse

Answer 11

1. Age of child - 70% of abuse under 3 years old
2. Young parent
3. Untreated mental illness or addiction
4. Single parent
5. Unrelated male caregiver
6. Poverty
7. Domestic violence
8. Corporal punishment

Question 12

Abusive Bruising Characteristics

Answer 12

1. Multiple bruises in soft tissue or protected locations - ie back, chest, abdomen buttocks
   - Infants and non-ambulatory
   - Patterned bruising

Question 13

Bruises Differential Dx

Answer 13

1. DIfferential diagnosis: Bleeding disorders, benign skin findings (Mongolian spots)
2. REMEMBER — the presence of a bleeding disorder dors NOT rule out abusive injury **TEST
3. Bruises cannot be dated

Question 14

Rib Fractures

Answer 14

1. Posterior rib fractures required anterior and posterior force. ABUSE

Question 15

Fractures DIfferential

Answer 15

1. Rickets, Osteogenesis Imperfecta, Osteopenia of prematurity
2. Screening labs to consider in kids <1 yr — 25-oh-vitD, Ca, Phos, AlkPhos, PTH
3. The absence of bruising does NOT r/o abuse

Question 16

Burns Abusive

Answer 16

1. Larger and deeper, bilateraly, younger children
2. Delay in seeking care
3. Is there evidence of patterned injury? Submersion, contact
4. Any burn have be abusive

Question 17

Abusive Head Trauma (AKA Shaken baby syndrome)

Answer 17

1. Subdural hemorrhage
2. Cerebral edema
3. Retrinal hemorrhages

Question 18

Abusive Abdominal Trauma

Answer 18

1. Uncommon <1%. 4% of abdominal injuries are abuse
2. Consider S/sx’s of — Bruising, abdominal pain or vomiting
   - Screen with amylase, lipase, and LFT labs
   - If labs are elevated LFT’s >80, lipase >100, and amylase> 50 consider abdominal CT

Question 19

Failure to Thrive/Nutritional neglect

Answer 19

1. Always think about psychosocial factors when presented with a case of failure to thrive — Even in context of a known medical condition**