peds: child abuse Flashcards
5 ways to define child abuse
Causes or threatens to cause …
1) non-accidental physical or mental injury.
2) “ “ “ “ during the manufacture or sale of certain drugs.
3) Neglects or refuses to provide adequate food, clothing, shelter, emotional nurturing, or health care.
4) Abandons the child.
5) Fails to provide adequate supervision in relation to the child’s AGE and LEVEL OF DEVELOPMENT
4 types of child abuse
Physical Abuse
Sexual Abuse
Emotional Abuse
Neglect
do you want to try to “date” a bruise (describe as old or new) ?
NO! only describe it
what happens to a “shaken baby” and what are the common signs?
Injuries often lethal to the brain or spinal cord that occur when shaken (examples include weak cry , inability to suck on bottle or pacifier, intractable vomiting, lethargy
abuse may results in ____ or _____ injuries
pattern (i.e. extension cord, boot mark, etc.)
non-obvious (i.e. lip, back of ears)
what is a key part of the motivation behind sexual abuse?
the perpetrator is in a position of power or control over the victim.
what is the ideal viewing position for sexual abuse?
supine frog leg
where may gonorrhea be found in pre-pubertal pts?
pre-pubertal: endocervical tissue, urethra and vagina in pre pubertal patients
dx of gonorrhea for post-puberty, sexually active pts?
Post pubertal patients who are sexually active, diagnosis (of abuse) may be hard to determine abuse verses from consensual intercourse
chlamydia: adolescents may be asymptomatic for ___ years.
3
chlamydia Infects the _______ ______tissue in adolescents
epithelium endocervix
Chlamydia:
Perinatal transmission is ___ to ____ %
Perinatal transmission can be up to age __
Presence of Chlamydia after age __ with no positive history from mom, considered highly suspicious.
50-75%
1
Presence of Chlamydia after age 1 with no positive history from mom, considered highly suspicious
gonorrhea txt:
chlamydia txt:
GC: rochephin
chlamydia: azithroymycin + doxycycline
trichomonas txt:
flagyl
how is trichomonas transmitted? more often in abuse cases of teens or children?
- exclusively via sexual contact
- More common in sexual abuse of the adolescent
- Not a lot of evidence of transmission with sexually abused children who was asymptomatic
is a child doesn’t show up with HPV at birth (from mom) but rather at __ - __ yo, it is a sign for abuse?
3-4 yo
defining characteristics of emotional abuse (what do the abusers do?)
Abusers constantly reject, ignore, belittle, dominate and criticize the victims.
signs of emotional abuse: child (weeds)
Shows sudden changes in behavior
Has not received help for physical or medical problems brought to the parents’ attention
Is always watchful, as though preparing for something bad to happen
Is overly compliant, passive, or withdrawn
Comes to school or other activities early, stays late, and does not want to go home
signs of emotional abuse: parent (weeds)
- has little concern for the child
- Denies the existence of—or blames the child for—the child’s problems in school or at home
- Sees the child as entirely bad, worthless, or burdensome
signs of emotional abuse: child and parent (Weeds)
Rarely touch or look at each other
Consider their relationship entirely negative
State that they do not like each other
“withholding of medical treatment or nutrition from disabled infants with life-threatening conditions” is what? .
medical neglect
__-__% of reports of abuse by a child are false. why is this significant?
2-5%
believe the child when they report it!
On average a child will disclose more than __times before he or she is taken seriously. who is this reporting to mostly?
5 times
mostly when telling the parents… are they are reporting to them more than anyone
Often if there is more than one child in the home…
the other children are probably being abused also.
3 dermatology issues that can mimic abuse
Lichen Sclerosis:
Seen between 3 and 7 years of age
Symmetric redness with shiny white patches
Urethral Prolapse:
Most common between ages 5 to 8 years old
Contact Dermatitis:
Can present as open ulcers depending on severity
2 non-abuse injuries that can mimic abuse
Straddle Injuries:
History is the key
(fell on a toy)
Labial Adhesions:
Most common under 2 years of age.
Thin Translucent line
what is “coining” ?
Long standing Asian fold remedy, special oil is applied to a coin and stroked in a pattern
what are “mongolian spots”
Blue spots that are flat bluish to bluish gray in color that appear at birth or shortly thereafter.
Commonly found at base of spine, buttocks and back, also can be on shoulders
BENIGN, NOT ABUSE
emergency care for abuse: how can you “gain entry” with the child?
low tone voice and assure them you are their to help
emergency care for abuse: what are some key things to remember when dealing with the child, getting their story?
Speak softly and use first name (not by “sweetie, honey, etc.), try not to ask the child what happened in detail because the abuser may still be present and the child will have to recall the events in detail multiple times. DON’T MAKE PROMISES!
emergency care for abuse: PE of child
Head to toe assessment must be performed! Look closely for signs of head injury or abdominal trauma. Often the abuser will not hurt the child in areas where clothing does not cover.
do not ask the caregiver…
DO NOT ASK THE CAREGIVER ABOUT ABUSE OR ACT ACCUSATORY TO THE CAREGIVER.
document everything but be _______
objective!
why is mandatory reporting important especially pertaining to VA laws?
study found that Reporting suspicions to hospital personnel DID NOT ensure that a report would be made to the Child Abuse Hotline or the appropriate agency
Mandated reporters who fail to report suspected child abuse or neglect, within __ hours of first suspicion, can be charged with a ______
72 hours
misdemeanor
mandated reporter: if found guilty of failing to report what is the cost for the first and any following incidents?
the fine is up to $500 for the first incident, and from $500-$1,000 for any subsequent incidents
signs of compassion fatigue syndrome
withdrawal, overwhelmed feeling, fatigue, inability to enjoy life, inappropriate anger, may feel inadequate, in over your head, want out
