Non-accidental Injury and Abuse Flashcards
Types of abuse
What does neglect mean?
What is facitious/fabricated illness mean?
Physical
Sexual
Emotional - can be from parents arguing
Neglect
Avoidable accidental injuries
Symptoms caused/faked by paretns for attention
Features of history and exam which suggests abuse
Disclosure by child
Injuries/signs which (a) don’t the story
(b) dont fit the development stage
(c) dont fit togerther as recognised as illness
Late presentation
Efforts to avoid full examination
Suspicious injuries and sites
Injuries on soft tissues
Facial injuries especially the cheeks - forehead can be hurt easily from accidents
Injuries to nappy area - sexual abuse
Fractures
Blow with flat intrument or hand will show spared skin at the sight of contact and purpura around the edges
Burns or marks indicates burn with hot object
Signs of sexual abuse
Vaginal/rectal bleeding or soreness
Inappropriate sexual behavious
Prepubertal STI - indicates abuse until proven otherwise
Warts can be an STI or transmitted vertically
Pregnancy at a young age
Late onset encopresis / enuresis
Shaken baby syndrome:
4 thing that happen and some signs you would see
Cerebral oedema - looking for bulging fontanelle and Increased head circumference
Subdural haemorrhage
Retinal haemorrhages and detachment
Rib/long bone fracture
Risk factors:
Parental
Child
DA Chronic ill health Mental health problems Drug and alcohol use problems Learning difficulties Low socioeconomic class Social isolation
Unwanted
Disabled
Behavioural problems
Differentials
Mongolian blue spot - usually on bottocks
Capillary haemangioma including strawberry nervus
Osetogenesis imperfecta leading to fractures
Investigations:
Examinations
Bloods
Imaging
Fundoscopy
Examination by trained specialist to see if they suspectr sexual abuse
Clotting screen - FBC
Bone biochemistry - e.g. calcium
Skeletal survery
CT head if indicated
Medical photo of affected area
Management:
Who can be contracted in the hospital?
What about outside hospital?
Other issues?
Consultant/reg
Safeguarding team
Other health professionals
Confidentiality can be breached
Social services
Police if immediate danger
NSPCC - long term management
Protection of siblings or other vulnerable people in the house
What is child in need referral?
Who tends to get them?
When may they be needed?
Done with parent’s consent when the child is not likely to reach their educational and social potential without local authority support
Kids with disabilities
Periods of family stress or parent incapacity or cases of neglect/emotional abuse
What is a child protection referral?
What about the parents>?
Use for chuildren you suspect of suffering abuse
Parents should be informed but consent is not required
Informing parents is not required if there is increased risk to the child
