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Paediatrics > Psychiatry/Social Medicine > Flashcards

Psychiatry/Social Medicine Flashcards

1
Q

HCPs must protect children from harm. Other than physical and sexual abuse, what other forms may present?

NB: witnessing intimate partner violence is also one

A
  • neglect
  • emotional abuse
  • sexual exploitation
  • fabricated illness (Munchausen)
  • female genital mutilation
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2
Q

What are the 4 rights of the child from the UN convention of rights of the child 1989

A
  • survival rights (food, shelter, healthcare)
  • developmental rights (to achieve full potential)
  • protection rights (vs all forms of abuse/discrimination)
  • participation rights (active role in communities)
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3
Q

Who should be involved in suspected child abuse cases?

A
  • Important to involve MDT in all cases e.g paediatric radiologist/ortho surgeon
  • involve seniors
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4
Q

What is emotional abuse?

A

-persistent emotional maltreatment of child –> severe and persistent adverse effects on the child’s emotional development

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5
Q

Suggest some ways emotional abuse may be directed: e.g. telling child they are ____

A
  • worthless
  • unloved
  • valued only as far as they meet x’s needs
  • inappropriate expectations put on child
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6
Q

Serious bullying that causes child to feel in danger,

exploitation/corruption of child are examples of what type of child abuse?

A

Emotional abuse

(it’s involved in all forms of maltreatment but may occur alone_

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7
Q

Sexual exploitation is abuse in which children are sexually exploited for ____, ___ or _____

A

money, power or status

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8
Q

neglect is the persistent failure to meet a child’s basic ____ and/or _____ needs, likely to result in the serious _____ of the child’s health or _______.

A

physical and/or psychological

serious impairment, health or development

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9
Q 
Neglect may involve carer failing to provide:
-
-
-
-
-
or to meet child's basic emotional needs
A
  • adequate food/clothing
  • shelter, e.g. excluding from home/abandoning
  • protection vs physical/emotional harm
  • adequate supervision
  • access to appropriate medical care
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10
Q

Fabricated/induced illness is a group of behaviours which involves the carer causing harm to the child.

  • Describe verbal fabrication
  • who is used as the instrument to harm? how?
A
  • parents invent signs/symptoms in child, telling false story to HCPs leading them to believe child needs Ix/Rx
  • then medical/nursing staff are used as the instrument to harm through unnecessary Ix/meds, intrusive tests/surgery
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11
Q

Fabricated/induced illness is a group of behaviours which involves the carer causing harm to the child.
-what may induction of illness involve?

A
  • suffocation of child
  • administering noxious substances/poison
  • excessive administration of ordinary substance e.g salt
  • the use of medically provided portals of entry e.g. central lines
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12
Q

Fabricated/induced illness is v hard to diagnose, what features may point towards this diagnosis? What pattern of presentation/symptoms?

A
  • frequent unexplained illnesses
  • multiple hospital admissions
  • symptoms that only occur in carers presence
  • symptoms not substantiated by clinical findings
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13
Q
  • child safeguarding is _______ responsibility

- there should be a ____-centred approach based on a clear understanding of needs and views of children

A
  • everyone’s responsibility

- child-centred approach

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14
Q

Give 2 risk factors for child abuse based on factors in the child:

A
  • failure to meet parental expectations/aspirations
  • wrong gender/disabled/’difficult’ child
  • born under forced/coercive/commercial sex
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15
Q

Give 2 risk factors for child abuse based on factors in the parent/carer:

A
  • mental health problems
  • parental indifference/intolerance/over-anxiousness
  • alcohol/drug-abuse
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16
Q

Give 2 risk factors for child abuse based on factors in the family:

A
  • step-parents
  • domestic violence
  • multiple/closely spaced births
  • social isolation/lack of social support
  • young parental age
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17
Q

Name 1 risk factor for child abuse based on factors in the environment:

A
  • poverty

- poor housing

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18
Q

name some factors to consider in the presentation of a physical injury in a case of suspected child abuse:
e.g. inappropriate reaction of carer (vague/evasive/unconcerned/excessively distressed)

A
  • child’s age/development
  • history given by child (if can communicate)
  • plausability of injury/reasonableness of explanation
  • background e.g. past child protection concerns, multiple A&E/GP visits
  • delay in reporting injury
  • inconsistent history from caregivers
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19
Q

Suggest fracture features that may suggest child abuse inflicted injury:

A
  • fracture in non-mobile child
  • rib fractures
  • multiple fractures (unless signif accidental trauma)
  • multiple fractures of different ages
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20
Q

Suggest bruises features that may suggest child abuse inflicted injury:

A
  • bruising in shape of a hand
  • bruises on neck that look like attempted strangulation
  • bruises on wrists/ankles like ligature marks
  • bruise to buttocks in a child <2yrs or any age w/o good explanation
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21
Q

Suggest burn features that may suggest child abuse inflicted injury:

A
  • any burn in a child that is not mobile
  • in shape of an implement e.g. cigarette, iron
  • ‘glove or stocking’ burn consistent with forced immersion
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22
Q

Consider neglect if the child:
(in a medical setting)
e.g. says there’s no one at home to provide care

A
  • consistently misses medical appts
  • lacks needed medical/dental care/immunisations
  • seems ravenously hungry
  • dirty
  • inadequate clothing in cold weather
  • abusing alcohol/other drugs
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23
Q

Consider neglect if the parent/caregiver:

in a medical setting

A
  • appears indifferent to child
  • seems apathetic/depressed
  • behaves irrationally/in a bizarre manner
  • is abusing alcohol/other drugs
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24
Q

Give a couple of features of behaviour of the child or the carer that may suggest emotional abuse, in children of baby age:

A
  • apathetic
  • delayed development
  • non-demanding
  • described by mother as ‘spoiled/attention seeking/in control’
25
Q

Give a couple of features of behaviour of the child that may suggest emotional abuse, in children of toddler/nursery age:

A
  • violent
  • apathetic
  • fearful
26
Q

Give a couple of features of behaviour of the child that may suggest emotional abuse, in children of school age:

A
  • wetting/soiling bed
  • relationship difficulties
  • non-attendance
  • anti-social behaviour
27
Q

Give a couple of features of behaviour of the child that may suggest emotional abuse, in minors of adolescent age:

A
  • self-harm
  • depression
  • oppositional
  • aggressive
  • delinquent behaviour
28
Q

What is an important form of emotional abuse in school-aged children that should be recognised/picked up/acted on?

A

-bullying by other children

29
Q

Suggest what sort of presentation may a young person come with that would make you suspicious of sexual abuse in a child?

A
  • child identified in pornographic material
  • child pregnant if under age of 13=abuse
  • STI with no clear explanation
30
Q

Suggest a sign/symptom a young person come with that would make you suspicious of sexual abuse in a child?

A
  • vaginal bleeding
  • discharge, itching
  • rectal bleeding
31
Q

Suggest what sort of behavioural symptoms a young person may come with that would make you suspicious of sexual abuse in a child? (same applies for emotional abuse) plus:

A
  • unexpected awareness/acting out sexualised behaviour beyond what is expected for age
  • soiling, secondary enuresis (wet bed)
  • self harm, aggressive or sexualised behaviours
  • regression
  • poor school performance
32
Q

What are the challenges in examining a child with suspected sexual abuse?

A
  • few diagnostic signs
  • hard to find positive findings even days post-assault
  • genital heal v quickly
  • sexual abuse often is without much physical force (less signs)
  • forensic material decays rapidly
33
Q

Due to the challenges in examining a child with suspected sexual abuse, an expert doctor with _____ should examine, important tests to run include:

A
  • expert with specific training and facilities for photographic documentation
  • STI screening and management
  • if needed: forensic testing for DNA may reveal perpetrator body fluid
34
Q

What type of imaging should be done in all children with suspected physical abuse <30months old?

A

-full radiographic skeletal survey
-with oblique views of ribs
(NB: some lesions may not be seen initially but become evident on a repeat x-ray 1-2weeks after if indicated).

35
Q

What medical conditions may explain suspected physical child abuse in the form of bruising, fractures, and scalds/cig. burns?

A
  • bruising-coagulation disorders, Mongolian spots
  • fractures-osteogenesis imperfecta type I
  • scalds-bullous impetigo, scalded skin syndrome
36
Q

Osteogensis imperfecta type I is an ___ condition that often presents with unexplained ____, child may have ___ ___ and there will be generalised _____ and Wormian bones in the skull (____ ____ within skull sutures)

A
  • AD condition
  • unexplained fractures
  • blue sclera
  • generalised osteoporosis
  • Wormian bones (extra bones within sutures)
37
Q

If brain in jury is suspected, all children require:

e.g. what form of imaging? who needs to examine x for what? Screen of what?

A
  • immediate CT head followed later by an MRI
  • a skeletal survey to exclude fractures
  • an expert ophthalmologist to rule out retinal haemorrhage
  • a coagulation screen
38
Q

Any child abuse injuries should be carefully noted, what detail needs to be taken?
NB: notes must be meticulous, signed, dated and timed on each page

A
  • injuries should be measured, recorded and drawn on a body map and photographed (with consent)
  • height, weight and head circumference, record and plot on a centile chart
  • note interaction between parents and child
39
Q

When dealing with any child suspected of been abused, what else should be considered? Who should be involved?

A
  • the safety of other siblings/children living at home

- police and/or social services

40
Q

Signs of depression in child/adolescents?

e.g. -guilt/despair, lack of motivation

A
  • social withdrawal
  • apathy, boredom, inability to enjoy oneself
  • separation anxiety reappearing
  • decline in school performance
  • hypochondriacal ideas/pain chest/abdo/head complaints
  • irritable mood/frankly antisocial behaviour
41
Q

What is it important to ask about depression in child/adolescents? Why should you talk to child alone?

A
  • ask about feelings directly and about suicidal ideas/plans

- teenagers out of loyalty may pretend to parents that all things are all right

42
Q

Treatment of depression in child/adolescents depends on severity, children with mild symptoms can be managed in 1 care, and often recover spontaneously ~4weeks observe, if 2-3months later no response, who to refer to?

A

-specialist mental health services

mod-severe depression should be referred immediately

43
Q

children with mod-severe depression should be referred immediately to specialist Mental Health services, what rx may be available for them?

A
  • psychological intervention e.g. CBT
  • family therapy
  • interpersonal therapy
  • identifying contributing factors e.g. bullying
44
Q

children with mod-severe depression under specialist Mental Health services for CBT/therapy that do not respond after _weeks, what should be considered?

A
  • after 6 weeks

- consider SSRI e.g. fluoxetine

45
Q

Depressed young people who are suicidal may need ___

A

-admission to an adolescent inpatient unit

46
Q

Name a few reasons why some children may deliberately be self-harming?

A
  • coping technique for negative feelings e.g. low self-esteem
  • expressed wish to punish themselves
  • positive feeling of control they experience when harming
  • physical pain as a distraction from emotional pain
47
Q

15% adolescences self-harm during development, many don’t actively present to HCPs so in assessing an adolescent with emotional/behavioural difficulties, what must you ask about?

A

-ask about self-harm, consultation is not complete until you do so

48
Q

Name common methods of self harm other than cutting:

A
  • burning
  • scratching
  • tying ligatures round neck
  • punching walls (suspect in boxers fractures)
49
Q

How may you notice signs of deliberate self harm in an adolescent?

A
  • full physical examination good time to look
  • cutting into thighs can often be missed
  • pt wearing long sleeves/reluctant to show skin should raise concern
50
Q

How to ask about deliberate self harm in an adolescent?

e. g. -validate the young persons distress, -assure…
- normalisation of the problem is key

A
  • take history w patient alone
  • create safe environment
  • allow enough time to conduct consultation sensitively, wo interruptions
  • set rules of confidentiality out clearly
  • give assurance they will be supported
  • ask questions directly but sensitively
51
Q

Suggest a good phrase to ask about self-harm/suicide in a low mood adolescent:

A

-sometimes if people are feeling particularly stressed worried or low, they can have thoughts about harming themselves, or ending their lives. Has this ever happened to you?”

52
Q

The screening tool PATHOS can be used to assess suicide risk after adolescent overdose, what do the letters stand for?
NB: P, A, T, HO, S

A 
P-Problems
A-Alone
T-Three hours
HO-Hopeless
S-Sad
53
Q 
explain this tool for suicide RA post overdose:
P-Problems
A-Alone
T-Three hours
HO-Hopeless
S-Sad
A
  • Have you had PROBLEMS > 1month?
  • Were you ALONE in house at the time?
  • Did you plan the OD for longer than THREE hours?
  • Are you feeling HOPELESS about the future?
  • Were you feeling SAD for most of the time before the OD?
54
Q 
In this tool for suicide RA post overdose, each q is worth 1 point, child is at high risk if score is >\_\_, but final judgement...?:
P-Problems
A-Alone
T-Three hours
HO-Hopeless
S-Sad
A
  • if >2points = high suicide risk

- final judgement is a clinical and qualitative decision not one based on a cut-off score

55
Q

When will a man have parental responsibility:

A
  • father on birth certificate (even if not biological father)
  • father at time of birth if was married to the mum
56
Q

What are the 3 risk factors used to predict the risk of recurrence of a febrile seizure?

A
  • young age at onset <18months
  • family history of febrile seizures
  • seizures at temperature <40 degrees
57
Q

What is the risk of developing epilepsy after febrile seizures in healthy children?

A

3%

58
Q

What medication can help with febrile seizures?

A

-Paracetamol/NSAIDs (anti-pyretics)

Paediatrics (12 decks)

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