Non Accidental Injury: Abuse and Neglect Flashcards
What is child maltreatment?
Any non accidental behaviour that is outside the norms of conducts and entails a substantial risk of causing physical or emotional harm to a child or young persons. May be international or unintentional and can include acts of commission (i.e. neglect) and commission (i.e. abuse)
What are the 4 types of abuse?
- Physical
- Emotional
- Neglect
- Sexual abuse
What is physical abuse?
Non accidental use of physical force against a child that results in harm to the child +/- intent. Some physical forces are considered abusive even if no injury results Includes fabricated / induced illness by a parent / carer.
What is emotional maltreatment / psych abuse?
Inappropriate verbal or symbolic acts toward a child and or a pattern of failure over time to provide a child with adequate non physical nurture and emotional availability. Can damage a child’s self esteem or social competence.
What are the 5 main forms of emotional maltreatment?
- rejecting
- isolating
- terrorising
- ignoring
- corrupting
What are the forms of neglect?
- physical (includes medical neglect)
- emotional
- educational
- environmental
What is family violence
Children being exposed to a parent or sibling being subjected to physical, emotional or sexual maltreatment
What is the most common type of abuse?
Emotional
Child factors predisposing to abuse?
- Age (older- PA)
- Sex (girls - SA)
- Race
- Difficult behaviour
- Disabilities
- MH problems
Where are concerning locations to identify bruising?
- Ear bruising
- Buttock bruising
- Back bruising
What may be inferred by the colour of a bruise?
When yellow more than likely to have occurred more than 18h ago
What are the priorities in dealing with child abuse?
- Diagnose, treat and document injuries
- Interpret pattern of injury or behaviour leading to suspicion of abuse
- Notify VFPMS
- Provide (with consent) verbal or written report to CP and police
Ix for fracture suspected of resulting from NAI?
- XR directly
- Bone scan
- Skeletal survey
(useful for detecting clinically unsuspected recent and older fractures). Use both if less than 3y and suspicion NAI.
Mx Sexual Abuse?
Recent (under 72h) needs rapid evaluation
- Contact VFPMS asap
- Treat urgent medical problems (i.e. bleeding)
- Ensure child comfortable
- Emotional support
- If possible, avoid food and drink toiling until VFPMS advises collection of samples
What child characteristics place them at greater risk of NAI?
- Speech and language disorders, learning disabilities, conduct disorders
- FTT
- Congenital anomalies, ID, chronic illness
- ADD / ADHD
- Unplanned pregnancy
- Unwanted child
What environmental characteristics place child at greater risk of NAI?
- Unrelated adolescent / adult male in house
- Domestic violence
- Animal cruelty
- Family stressors (divorce, job loss)
- Poverty
- Social isolation
What caregiver features predispose to NAI?
- Young or single
- Lower education
- Unrealistic expectations
- Negative perception of normal behaviours
- Caregiver was abused
- Substance / EtOH abuse
- Psychiatric ilness
Red flag Hx features for NAI?
- No Hx or denial of trauma despite severe injury
- Implausible Hx for degree or type of injury
- Unexplained delay in seeking care
- Attributed to home resuscitative efforts
- Caregiver Hx that changes with retelling, conflicts with others
- Severe injury explained as self inflicted, blamed on other children / pets
What are the two major types of implausible mechanism provided to explain injury?
- Inadequate mechanism to explain severity
- Developmentally improbably (e.g. pt turned on hot water faucet)
Red flag areas for NAI to assess on PEx?
- Scalp and fontanelles
- Ears
- Oral cavity
- Folds of neck
- buttocks
- Genitals
- Palms and soles
Red flag features of bruising?
- bruising less than 6m old
- 1+ bruise pre mobile infant, 2+ bruise crawling
- on torso, ear, neck or buttocks
- striking object pattern (slap, belt, loop mark)
- human bite marks
Red flags for intentional burns?
- scalds under 5y not fitting pattern of unintentional spill
- scalds from hot tap due to immersion with “high tide” mark
- sharply demarcated edge in area of burning object
- cigarette burns
- stun gun burns
Fractures suggestive of NAI?
- Metaphyseal corner fractures
- Rib #
- # sternum, scapula or spinous process
- long bone # in non-ambulatory infant
- multiple #s
- vertebral # w/o high force trauma Hx
- digital in under 36m
- epiphyseal separations
- severe skull #
