Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatric Optometry > Pediatric Optometry: L1: Child Abuse > Flashcards

Pediatric Optometry: L1: Child Abuse Flashcards

1
Q

Epidemiology

  1. # of Child Abuse Cases reported each year?
  2. Number of Fatalities?
  3. % w/Initial Presentation to ECP?
  4. Ocular injuries present in what % of physical abuse cases?
    a. % of Direct Trauma to the eye?
  5. Why is it important to detect Child abuse on 1st visit?
A
  1. 1.25 million (1/58 kids)
  2. 1,740 in 2008 (2.33/100,000)
  3. 4-6%
  4. about 60%
    a. about 20%
  5. Because about 50% of kids will have further abuse done, and up to 10% chance of mortality if physical abuse is not detected at initial presentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Child Abuse

  1. Who is considered a Child?
  2. How does CAPTA define abuse and neglect?
A
  1. Unmarried person under the age of 18. (But not an emancipated minor)
  2. An act of failure to act that presents an imminent risk of serious harm.

OR

Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse, or exploitation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Child Abuse

  1. Alternative Definition from H&HS?
  2. This DOS NOT prohibit any parent from using what?
    a. This includes, but not limited to what?
A
  1. Harm, threatened harm, or failure to protect frmo harm to a child’s health, safety, or welfare including non-accidental physical or mental injury, sexual abuse, and sexual exploitation
  2. ORDINARY FORCE as a means of discipline
    a. Spanking, switching, or paddling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Child Abuse Alternative Definition from H&HS

  1. Abandonment, failure or omission to protect child from exposure to what?
A
  1. Need to provide: good nurturance and affection, food, clothing, shelter, sanitation, hygiene, good education, MEDICAL, DENTAL, or BEHAVIORAL HEALTH CARE, supervision or appropriate caretakers, and special care needed for physical or mental condition of the child.
    * Also: not protecting child from use, possession, sale, or manufacture of illegal drugs, illegal activities, and sexual acts or materials that are not age-appropriate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Abuse and Neglet

  1. Abuse
    a. Estimated # of children?
    b. Physical?
    c. Sexual?
    d. Emotional?
  2. Neglect
    a. Estimated # of children?
    b. Educational?
    c. Physical?
    d. Emotional?
A
  1. a. 553,300 children
    b. 58%
    c. 24%
    d. 27%
  2. a. 771,700 children
    b. 47%
    c. 38%
    d. 25%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk Factors

  1. Girls are more likely to be neglected in what categories?
  2. Age?
  3. Employment
    a. Unemployment: Rate of Abuse? Neglect?
  4. Single Parent
    a. Abuse?
    b. Neglect?

5.

A
  1. In ALL CATEGORIES
  2. Older > Younger
  3. a. 2x’s rate; 3x’s rate
  4. a. 10x rate
    b. 8x rate
  5. a. 3x rate
    b. 7x rate
  6. more than 40%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Perpetrators

  1. Relationship to child
    a. Physical
    b. Emotional
    c. Sexual Abuse
  2. Sex of Perpetrator
    a. Biological Parents
    b. Non-Biological Parent/Partners
    c. Acute Head Traums
A
  1. a. 71% Biological Parents
    b. 73% Biological Parents
    c. 42% Non-Parent, 36% Parent
  2. a. Mothers (75%) > Fathers (43%)
    b. Males 75%
    c. Biological Father (50%) > Stepfather/Male Partner (20%) > Mother (12%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Medical Neglect

  1. Failure to provide Appropriate health care for child which includes what?
  2. Exception for medical neglect?
A
  1. Failure to provide prosthetics, including eyeglasses and hearing aids
  2. When a parent or other person responsible for child’s welfare is legitimately practicing religious beliefs and by reason thereof does not provide specified medical treatment for the child.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

American Academy of Pediatrics

  1. 2 Forms of Medical Neglect?
A
  1. Failure to heed obvious signs of serious illness and failure to follow what a physician tells u after medical advice has been sought.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

American Academy of Pediatrics

  1. Factors Considered Necessary for Dx of Medical Neglect
A
  1. Child is harmed or at risk of harm due to lack of health care
  2. Recommended health care offers significant net benefit to the child
  3. Anticipated benefit of Tx is significantly greater than its morbidity, so that reasonable caregivers would choose treatment over non-treatment
  4. It can be demonstrated that access to health care is available and not used
  5. The Caregiver understands the medical advice given
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why do families fail to seek appropriate medical care?

A
  1. Poverty or economic hardship
  2. Lack of access to care
  3. Family chaos or disorganization
  4. Lack of awareness, knowledge, or skills **
  5. Lack of trust in healthcare professionals **
  6. impairment of caregivers,
  7. Caregiver’s belief systems
  8. Child’s attitudes and behavior**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  1. What should ALWAYS be the DDx if a child presents with a TRAUMATIC INJURY?
A
  1. ABUSE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Exam: History

  1. If an injury is seen, what is our responsibility?
  2. Documentation should have what?
A
  1. Determine detailed Hx of:
    a. Preceding activities/events leading to trauma event
    b. Mechanics of the Injurious circumstances
    c. Subsequent actions and symptoms of the patients
  2. Statements from child/parent should be recorded as DIRECT QUOTATIONS to lessen the chance that they may be dismissed as “heresay.”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Exam: Interviewing the Child

  1. WHAT SHOULD BE AVOIDED?
  2. What questions should we ask?
  3. What questions should we start with?
    a. WHAT SHOULD BE AVOIDED?
A
  1. Avoid repeating questions (child may change answer if they think initial answer was incorrect and modify response)
  2. SIMPLE QUESTIONS (If a child doesn’t understand the question, they will try answering it anyways…which can lead to wrong info)
  3. OPEN-ENDED Questions, then ask questions that lead to more specific answers
    a. AVOID asking YES/NO QUESTIONS! (These have been shown to be inaccurate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Exam: Patient/Parent Observation

  1. What should we be looking at w/Family members?
  2. Suspicious behaviors of family members?
A
  1. Watch interaction b/w family members during evaluation
  2. Arguing, roughness, violence. Aloofness/Lack of emotional response b/w parents or b/w parent and child; Inappropriate response to severity of injury and Inappropriate delay in seeking medical care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Exam: GROSS OBSERVATION:

  1. What is PRESENT in 90% of ABUSED CHILDREN?
  2. ACCIDENTAL FALLS MOST OFTEN RESULT in what?
    a. Examples?
  3. Inflicted Injuries frequently involve what?
    a. EXAMPLES?
A
  1. BRUSING
  2. In Bruising over BONY PROMINENCES
    a. Forehead, Cheek Bone, Chin, Elbows, Knees
  3. SOFT, FATTY AREAS
    a. Cheeks, Mouth, abdoment, back, thighs, EARS, and UPPER Arms
17
Q

Bruising: Suspicious of Multiple injuries in various Stages of Healing

  1. Timing of Bruising by COLOR!
    a. 24 hrs?
    c. ~1 Wk old?
    d. ~1-2 wks old?
    e. > 2 Wks old?
A
  1. a. RED
    b. Blue/Purple

c. Blue/Yellow
d. Yellow/Green
e. Brown

18
Q

Exam: Anterior Segment Findings

  1. Adnexa: What 4 things should we look for?
A
  1. Periorbital Ecchymosis
  2. Edema
  3. Lid Laceration
  4. Phthiriasis Pubis
19
Q

Exam: Anterior Segment Findings

  1. Conjunctiva: What 2 things?
A
  1. Conjunctivitis (Think CHLAMYDIAL Conjunctivitis)

2. Subconjunctival Hemes

20
Q

Exam: Anterior Segment Findings

  1. Cornea: What 4 things?
A
  1. Scarring
  2. Edema
  3. Corneal Staining
  4. Laceration
21
Q

Exam: Anterior Segment Findings

  1. Anterior Chamber: What 3 things?
A
  1. Angle Recession
  2. Hyphema
  3. Iris Tear
22
Q

Exam: Anterior Segment Findings

  1. Lens: What 4 things?
A
  1. Cataract
  2. Lens Dislocation
  3. Lens Subluxation
  4. Vossius Ring
23
Q

Exam: Posterior Segment Findings

  1. Optic Nerve: What 2 things?
A
  1. ONH Edema (Acute trauma…)

2. Optic Atrophy

24
Q

Exam: Posterior Segment Findings

  1. Retina and Choroid: What 5 things? (usually seen more acutely)
A
  1. Choroidal Rupture
  2. Commotio Retinae
  3. RD
  4. Retinoschisis
  5. Retinal Hemes
25
Q

Exam: Posterior Segment Findings

  1. Suspected Abusive Head Trauma (Shaken Baby Syndrome)
    a. DFE RECOMMENDED w/in how many hours?
  2. What is the CARDINAL ABUSE of Head Trauma?
  3. How to distinguish b/w accidental fall hemes and Abusive Head Trauma?
A
  1. 24-72 hrs!
  2. Retinal Hemes (~85% of cases of abusive head trauma)
  3. If a baby fell 6-10 feet, it will present with different types of retinal hemes vs. Abusive Head Trauma
26
Q

Exam: Posterior Segment Findings: Retinal Hemes

  1. What should we document about the HEMES?
  2. What kind of Hemes do we see in AHT?
A
  1. Number of Hemes seen, Pattern of Distribution, and Types of Hemes
  2. Too numerous to count, in ALL LAYERS (Pre-, Intra-, Sub-, Retinal) and Extend to the ORA SERRATA!
27
Q

Reporting

  1. Agencies?
  2. Do I have to report?
A
  1. Child Protective Services, Department of Social Services, and Local PD
  2. Laws vary state to state, including definition of child abuse, who is required to report, and who the report should be made to.
28
Q

Mandatory Reporting Arizona

  1. Who is required to report?
A
  1. Any physician, PA, OPTOMETRIST, Dentist, etc… who develop Reasonable belief in the course of treating a patient.

Peace officers, member of clergy, etc. Parent, Stepparent or guardian of the minor. Any school personnel or domestiv violence victims.

29
Q

HIPAA:

  1. Can we report it?
A
  1. Yes. Child abuse and neglect supersedes client-professional confidentiality.
30
Q

Reporting: how to make a report?

A
  1. Verbal report to the right agency
  2. Written report w/in a specified time frame
  3. Parents informed about disclosure
  4. CPS conducts initial eval and offers rehabilitative services to the family
  5. Law enforcement involvement if necessary (Crime suspected)
31
Q

Report: Written Report

  1. What’s the purpose?
  2. What language should it be written in?
  3. What should be on the report?
A
  1. Physician’s Primary tool to communicate to officials regarding abuse/neglect
  2. PLAIN LANGUAGE! No MEDICAL JARGON!
  3. Name, age, sex, address of children; Name and addresses of parents or person responsible for the child.

Time of injury in relation to presentation for medical care and the names of witnesses to injury.

Info about the setting of the alleged abuse (esp if injury occurred outside the home)

Hx of Child’s injury or condition as provided by parent, guardian, or accompanying adult

Physical Exam Findings; Photodocumentation as well if possible.

Reasons why abuse is suspected

32
Q

Recording: Optometry Record

  1. What should be included?
A

Hx of previous injuries/accidents

Procedures performed and photodocumentation if possible

Diagnosis: Include A/P “Suspected child abuse” followed by a descriptive summary of findings

Report: Include if a child abuse/neglect report was made and the details.

Final Disposition of child.

33
Q

Reporting

  1. Mandatory Reporting in Az: When to report?
  2. Where to Report?
  4. Failure to report = ?
A
  1. Immediately in person or by phone w/a written report w/in 72 hrs
  2. Peace officer or Child Protective Services in Department of Economic Security
  3. Names and Addresses of minor and parents. Minor’s Age. Nature and extend of any injuries or neglect, including evidence or previous injuries or neglect. Any other info that might be helpful
  4. Class 1 Misdemeanor if we violate this section. Failure to report involves a Reportable offense, then we are guilty of a CLASS 6 FELONY!

Pediatric Optometry (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions