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Childs Health > Non accidental injury > Flashcards

Non accidental injury Flashcards

1
Q

How many children die a week of child abuse

A

1-2 c

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2
Q

One in four young adults have experienced severe child abuse

A
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3
Q

General signs of neglect

A

Dirty skin, nappy rash, dirty and tangled hair, uncut nails, etc

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4
Q

How many children a year in the uk need child protection

A

50,000

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5
Q

Physicla ecicenc

A

Evidence old injuries
Multiple bruising
Xray - old and new fractures
Tearing of frenulum behind upper lip
Cigarette burns, bite marks
Indications of bleeding insice skull/brain
Child may well be withdrawn facial appearacnec fear - frozen watchfulness
STI/pregnancy

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6
Q

What is frozen watchfulness

A

Physcial abuse themselves
Witness domestic abuse
Watch everything thats happening around them

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7
Q

When are sus of NAI raised

A

Delay in presenation
Vague, elusive or changing history
Angry or abusive parents even when gently questioned
Discrepancy between witnesses, history and findings
Injuries in very ypung pre-mobile children

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8
Q

Risk factors child abuse

A

Prev episodes
Abuse in sibling
Single poorly supported parent
Domestic abuse
Substancve misuse in parent
Parent mental ill health
Child with disability
Long time in NICU

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9
Q

Toxic trio

A

Substance misuse
Domestic abuse
Parental mental ill health

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10
Q

What do not mention to parents about safeguarding?

A

Fabricated illness

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11
Q

What can do when concerned about safeguarding

A

Ring social services for advice - dont have to refer
Infrom parents
Speak to multiple seniors

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12
Q

Investigations fo rNAI

A

Blood test - FBC, coag screen
Skeletal survey
CT head
Opthalmoscopy

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13
Q

What is a askeletal survey

A

Radiographs skull, thorax, long bones, hands, feet, pelvis and spine
Repeat 7-10 dyas - can see healing fractures that may ahve been missed

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14
Q

Indications for skeletal survey

A

<2 any evidenve abuse
<5 suspicious fracture
Older child unable to communicate pain

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15
Q

NAI classical injuries

A

Classical metpahysal lesions
Posterior rib fractures
Scapular fractures
Spinous process fractures
Sternal fractures

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16
Q

Moderate specificity lesions

A

Multiple fractures
Fractures different afes
Epipjysea seperatuns
VERTEbral bodu fractures and subluxations
Digital fractures

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17
Q

Low specifity lesions

A

Clavicular
Long bone
Subperticular fractures

18
Q

What see on X ray in calssic metaphyseal fractures

A

Bucket handle - metaphysis gets sepreated
Corner fracture - corner sliced off by tendon - avulsion fracture

19
Q

CT hea dscan indications

A

All children under 1 if sus NAI
Any child with neurological symptoms

20
Q

What look for on CT head NAI

A

Subdrual bleeding
Diffuse axonal injury

21
Q

Differential diagnosis

A

Accidental injury
Osteogensis imperfecta
Clotting disorders
Mongolian blue spot
Scalded skin syndrome

22
Q

Osteogensis imperefecta

A

Autosomal dominant
Variable everity

23
Q

Mongolian blue spot

A
24
Q

Scalded skin syndrome

A

Groin and armpits staph infeciton
Treat with antibiotics
Unclear demarcation lines

25
Q

Referal to social care

A

Telephone-> in writing
Arrange assessment incl police
Child protection investigation if appropriate
Case conference - write report on child

26
Q

Sus abuse outcomes

A

Removal to place of safety - emergency foster carer
Case caonference
Child protection plan
Allow home with supervision and support
care by other relative
Foster care

27
Q

How much more likely is physical abuse when intimate partner violence occurs in first 6 months of life?

A

3.4 times as likely

28
Q

Indirect questions to ask in a history around NAI

A

Is everything ok at home
Is your partner supportive
If woman is preganant - looked after properly? partner taking care of you>

29
Q

Direct questions for NAI

A

Do you ever feel frightened of your partner
Have you ever been in a relationship where you have been hit or hurt in some way
Are you currently in a relationshup where thats happening to you

30
Q

Risk factors

A

Exceddive crying
Unintended pregnancy
Developmental problems

31
Q

What to not about bruises in NAI

A

Shape - hands, linear, ligatures
Pattern - non bony parts of body
Multiple brusies or clusteres bruises
Age - if cant mobilise - cant cruise dont bruise

32
Q

When should suspicions be high in lacerations or abrasions?

A

In non-mobile children
Symmetrically
Around face
Around ankles or wrists in position of ligature

33
Q

Where do thermal injuries raise sus of NAI?

A

Soles of feet
Buttocks/back
Back of hands
Shape - concerivbale implement eg cigarette or iron
Sharply delineated borders - immersion injury 0 donut (where bottom in contact with bottom of bath and rest is burned by water)

34
Q

Fractures when to investgiate for NAI

A

Single or mulitple ni those without medical condition predisposing
Different age fractures esp when no documentation
Metaphyseal corner fractures
Occult rib fractures - shaken
Spiral fractures

35
Q

When to suspect NAI with intracranial injuries

A

Without adequate explanation
< 3
In presence of:
Retinal haemorrhage
Rib o rlong bone fracture
Ass injuries
Multiple subdural haemorrhgae

36
Q

Differentials for NIA

A

Coagulopathy - excessive bruising and haemarthrosis
FH present - coag screen
Osteogensis imperfecta - FH + X ray

37
Q

When should a skeletal survey be repeated

A

11-14 days - periosteal reaction

38
Q

Acute vs non acute head presentation

A

Acute - CT
Non acute - MRI within a week

39
Q

What cna US be used for

A

can be used to diagnose metaphyseal and rib fractures as well as identifying subperiosteal fluid.

40
Q

What happens when sus NAI?

A
  • The child may be admitted to a paediatric ward as a place of safety whilst a social worker makes urgent enquiries and puts a safety plan in place.
  • Senior paediatric/child protection review should be undertaken.
  • A skeletal survey should be considered.
  • If abusive head trauma is suspected, the child should be referred for ophthalmology review to identify possible retinal haemorrhages.13

Childs Health (82 decks)

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