Peds Final - Child Abuse Flashcards
neglect
failure to provide for the child’s basic needs, provide adequate level
omission vs commission
consequences of global neglect
-developmental delay
-neuropathlogic consequences
-multiple minor scarring injuries
-parentification
-death d/t inappropriate supervision
-when paired w/ physical or sexual abuse, personality associated criminal & abusive behaviors
consider neglect when the child ….
-misses school lots
-begs or steals food or money
-lacks needed medical care
-consistently dirty
-lack sufficient clothing
-abuses alcohol or drugs
-states no one is at home
consider neglect when the parents
-appears to be indifferent to the child
-seems apathetic or depressed
-behaves irrationally or in a bizarre manner
-is abusing alcohol or drugs
family factors that put a child more at risk for being abused
-domestic violence
-isolation
-poverty / unemployment
-single parent
-animal abuse
-increased exposure between parent & child
-major life changes
parental characteristics that put a child more at risk for being abused
-substance abuse
-low self esteem
-poor impulse control
-abused as a child
-teenage parent
-negative view of child
-depression
-unrealistic expectations of child
-corporal punishment
factors in a child that puts them more at risk for being abused
-development disability
-hyperactivity
-resemblance to abusive person from past relationship
-prolonger or chronic illness
-colic #1 reason for abuse
-multiple birth
-lack of bonding
warning signs of abuse
-physical evidence
-no hx to explain physical findings
-injury not consistent w/ hx or developmental level
-delay in seeking medical attention
-changes in story
-parent blames the child or sibling
-seek medical attention far from home
-reaction to injury is inappropriate
behavioral characteristics of abused children
-don’t turn to parent for support
-overly compliant or passive
-aggressive towards animals
-school performance declines or have laerning problems
-do not want to go home
physical indicators of abuse
bruises, welts, lacerations, abrasions or broken bones esp those in various stages of healing & in atypical sites
what is the #1 sign of abuse
bruising that doesn’t make sense
between eyes, ears, groin, thighs or that look like something
rule of T-E-N in <4yrs old
Torso, Ears, Neck -> if bruised think abuse
mongolian spots
hyper pigmented deeper spots, often seen in darker skin people uniform color
what age is most likely to have severe affects if abused
infants
immediate signs and symptoms of PAHT
-seizure
-posturing
-unequal pupils, change in LOC
-retinal hemorrhages, vision loss
-pale, mottled, cold, clammy skin
-poor feeding & vomiting
-brusing
-decreased in smiling or vocalizing
-change in head control
-brady (both), apnea
-bulging fontanel
perpetrator characteristics
-male
-<30 yrs
-ed less than high school
-depression
-social isolation
-substance abuse
-low self esteem
-poor impulse control
risk factors in the child
-male
-colic
-low birth wt
-drug & alc exposure or withdrawal
-special needs
-infants w/ NAS
-being one of multiple kids
fractures for abuse
-spiral usually means abuse
-most common: femur, humerus, tibia
-multiple old ones
possible reasons for abuse of toddlers
-potty training can be hard
-temper tantrums
-perceived disobedience/disrespect
how do you know if it is an accidental burn
you have one intense area and then splash marks
non accidental is more uniform
5 S’s if child won’t stop crying
-shushing
-side/stomach positioning
-sucking
-swaddling
-swinging
6 fatal mistake
1) non specific signs & symptoms attributed to benign causes
2) dx injury as accidental
3) subtle physical exam clues missed
4) contaminate the hx
5) nice people gig
6) give the benefit of the doubt
nurses role when caring for a possible child abuse case
-meet needs
-prove a role model for parenting
-provide support
-document fully and objectively
-report
do not judge
if a child asks you not to tell, what do you do
never tell them you won’t tell but say I will do everything I can to protect you and keep you safe
sexual abuse stats
-1 in 7 child are abused
-1 in 3 girls by the age of 18
usually by someone in power and that the child knows and usually repetitive
do children make up sexual abuse
rarely
nursing interventions in sexual abuse
-always believe victum
-provide play opportunities for role play
-avoid leading statements
-never promise not to tell
MSP perpetrator characteristics
-usually mother
-thrive in health care environment
-some health care knowledge
-loving, cooperative, competent
-suggest tests & procedures
