Non-accidental injury (Child abuse) Flashcards
Define non-accidental injury.
Child abuse (including neglect) is any form of maltreatment of a child, either by inflicting harm or by failing to act to prevent harm. Children may be abused in a family, institutional, or community setting, by those close to them, such as a parent or caregiver or, more rarely, by a stranger. They may be abused by adults or by other children.
What are the 4 categories of non-accidental injury?
Physical abuse
Emotional abuse (also called psychological maltreatment)
Sexual abuse
Neglect
Explain the aetiology/risk factors for non-accidental injury.
No specific ateiological factor for child abuse; causes and risk factors are multifocal, but can be calssified as parent/carer risk factors or child risk factors.
What are parent/carer risk factors for non-accidental injury?
Poor socio-economic status (e.g., poverty, low income, and/or an economic crisis within the family). Other factors include inadequate child care and poor parental education.
The reported co-occurrence rate of domestic violence within the family or an ongoing abusive relationship between partners in a violent intimate relationship with child physical abuse ranges from 22% to 67%.
Psychological problems such as depression, stress, or other mental health problems of a carer may expose the child to abuse.
Substance abuse may inhibit the carer’s ability to recognise the needs of the child, contributing to neglect, and may cause financial hardship. In addition, some children can end up in the role of “carer” for non-functioning adults, placing a huge burden on them.
Unmet emotional needs on the part of the parent or carer may predispose towards neglect of a child.
Lack of parenting knowledge may lead to unrealistic expectations of the child.
Parental or carer exposure to maltreatment as a child is a risk factor for child abuse, with evidence of a pattern of abuse running through generations in some families. This is thought to be due to sex-role stereotypes and a repetition of a pattern of violence.
What are children risk factors for non-accidental injury?
Children with mental or physical health problems, particularly those with challenging behaviours, may be at a greater risk of abuse.
Children with disabilities have been noted to be twice as likely to be abused as non-disabled children, although maltreatment also contributes to disabilities.
Low birth weight appears to be associated with a greater risk of abuse.
Excessive crying and/or frequent tantrums have been associated with abusive head trauma (AHT).
Twins and other multiples face an increased risk for abuse.
Summarise the epidemiology of non-accidental injury.
In industrialised countries it is estimated that 4% to 16% of children are physically abused, around 10% are neglected or emotionally abused, 5% of boys and 5% to 10% of girls are exposed to penetrative sexual abuse, and 30% are exposed to any form of sexual abuse. Around 80% of child abuse is perpetrated by carers or parents.
What are signs and symptoms of physical abuse?
Physical symptoms and signs
Psychological symptoms and signs
A concerning interaction observed between the child and the parent or carer
The child may tell someone about the abuse
The abuse may be observed
What must be considered in the presentation of physical abuse?
The child’s age and stage of development
The history given by the child (if they can communicate)
The plausibility and/or reasonableness of the explanation for the injury
Any background, e.g. previous child protection concerns, multiple attendances to A&E department or GP
Delay in reporting the injury
Inconsistent histories from caregivers
Inappropriate reaction of parents or caregivers who are vague, evasive, unconcerned, or excessively distressed or aggressive.
How might a neglected child behave?
Consistently misses important medical appointments
Lacks needed medical or dental care or immunizations
Seems ravenously hungry
Is dirty
Is wearing inadequate clothing in cold weather
Is abusing alcohol or other drugs
Says there is nobody at home to provide care
How might the parent/carer of a neglected child behave?
Appears to be indifferent to the child
Seems apathetic or depressed
Behaves irrationally or in a bizarre manner
Is abusing alcohol or other drugs
How might a baby experiencing emotional abuse behave?
Apathetic, delayed development, non-demanding
Described by the mother as ‘spoiled, attention seeking, in control, not loving her’
How might a toddle/pre-school child experiencing emotional abuse behave?
Violent
Apathetic
Fearful
How might a child experiencing emotional abuse behave?
Wetting
Soiling
Relationship difficulties
Nonattendance
Antisocial behavior
How might a teenager experiencing emotional abuse behave?
Self-harm
Depression
Oppositional
Aggressive
Delinquent behavior
How might a child experiencing sexual abuse behave?
Tell someone about the abuse
Be identified in pornographic material
Be pregnant
Have an STI with no clear cause
