UNIT 2 CHILD MAL TREATMENT/ABUSE Flashcards
What are signs of child abuse and neglect?
- Changes in behavior
- Changes in school performance and attendance
- Unexplained injuries
- Changes in eating
- Changes in sleeping
- Lack of personal care or hygiene
- Comes to school early, stays late, and does not want to go home
- Risk-Tasking behavior
- Fear of certain places or people
- Returning to earlier behaviors (regression)
- Inappropriately dressed for the weather
- Inappropriate sexual behaviors
What are types of child maltreatment?
- Physical neglect
- Emotional abuse/neglect
- Physical abuse
- sexual abuse
What is physical neglect?
Deprivation of necessitites
1. Food
2. clothing
3. shelter
4. supervision
5. medical care
6. education
Most common form of maltreatment
May be due to a lack of knowledge of child’s needs, lack of resoures and cargiver substance abuse.
What is emotional maltreatment?
- Emotional neglect is the FAILURE to meet the needs of affection, attention and emotional nurturance
- Emotional abuse is the Deliberate attempt to destory or significantly impair a child’s self-esteem or competence
What are forms of emotional abuse?
- Rejecting
- Isolating
- terrorizing
- ignoring
- verbally assaulting
- overerly pressuring the child
What is physical abuse?
The deliberate infliction of physical injury on a child, usually by the child’s caregiver
What is the rule of thumb when it comes to spanking?
Rule of thumb for parents who believe in spanking as a form of discipline is that they should only use an open hand (no objects such as wooden spoons, paddles etc.,) and only on the seat of the pants (or buttocks area) with clothes on
Injury from abuse can occur from
what and result in?
Occur from
1. punching
2. beating
3. shaking
4. kicking
5. biting
6. throwing
7. burning
Results in
1. bruses
2. bites
3. burns
4. lacerations
5. Pinch marks
6. swelling
7. tenderness
What is sexual abuse?
- Persuading any child to engage in, or assisting another person to engage in, sexual conduct or stimulation of such conduct
This type of abuse has significally increased the past decade due to increased awareness and increased reporting.
In sexual abuse who is the typical abuser?
Male/Female who the victim KNOWS
Usually family members
1. Fathers
2. Step fathers
3. Relatives
What are methods used to pressure children in sexual abuse caces?
- Children are offered gifts or privileges
- The child is told that it is “okay to do so”
- They may meet the child’s need for love and affection
- PRessures them into secrecy by describing it as a “secret between us
- The offender plays on the child’s fear (of punishment, repercussions , abandoment)
What are physical signs/symptoms of sexual abuse?
- Injury to external genitalia, anus, mouth or throat
- painful urination
- Recurrent UTI’s
- Constipation or stool incontinence
- STI
- Difficulty walking or sitting
- preganacy
What are some emotional/psychological s/s
- Sexual comments, behaviors or play
- Regressive behavior (bed wetting)
- Personality change (withdrawn)
- May resist removing clothes for exam
- Phobias (dark, stranger, leaving the house)
- Reports nightmares
- Sudden change inappetite
Whar are causes of child maltreatment?
Exact cause is unknown
1. No single factor or group of factors is predictive of abuse
2. The interaction of these factors is thought to **increase the risk of abuse **occuring in a particular family.
Charcteristics of the child that contribute to mal treatment?
Children unintentionally contribute due to common characteristics:
1. Temperament
2. Ordinal position/birth order
3. Age- Brith to 1 year are at highest risk (must have all of their needs met by others). Children birth to 2 years comprise 25% of all victims
4. Prematurity, behavioral disorder, unwanted pregnancy, cognitive impairment, hyperactivity or physical disability or chronic illness
5. Usually, one child the victim of abuse
6. May be in a difficult developmental stage
- Colic
- Potty training
- Teenagers
7. Removal often places other siblings at risk
What are some parental characteristics that contribute to child maltreatment?
- History of abuse/neglect– “Parenting imprint”
- Difficulty controlling aggression
- Substance abuse
- Inadequate support systems (few supportive relationships
- Usually one parent that is the abuser, the other permits it
- Younger parents
- Socially isolated
- Marital problems
- single-parent families
- single-parent families that include an unrealated partner
- Low-income
- Little education
- Low self- esteem
Inadequate knowledge of appropriate parenting skills/inappropriate or unrealistic expectations for child’s developmental level can lead too….
Child maltreatment
What are some examples of unrealistic expectations related to developmental levels?
- A parent who almost severed their 8 months old penis due to incontinence when the parent was trying to potty train them
- An infant with a severed frenulum who refused to tak etheir bottle
- A toddler’s legs and wrists tied and amouth gagged because they woul dnot stop walking and talking
What is anticipatory guidance?
That is why “anticipatory guidance” with parents about normal growth and development is so important and should be part of a chlds well checks at the pedi office or clinic
What are environmental contributors that can lead to child maltreatment?
- Chronic stress
- Poverty
- Unemployement
- Poor housing/crowded living conditions
- Frequent relocation
- Divorce
- Daycare providers and babysitters (esp. if they have not been fully evaluated)
What are indicators within our assessment that indicate maltreatment has happened?
History:
1. Inconsistent with injury
- For exmaple, a concussion, broken arm and brusies all over the body from falling off of a couch onto a carpeted floor
2. Incompatible with the childs developement
- A 6 month- old turning on the hot water of the bathtub and climbing in and getting burned
3. Delay in seeking medical treatment
4. History changes with repetition
5. Contradictory histories
6. Non-accidental injuries (loop mark bruises)
What are differnet types of injuries that can happen with child maltreatment?
- Skin or soft tissue injuries
- Musculoskeltal injuries/fractures
- Abdominal injries
- Head injuries
What are examples of skin or soft tissue injuries?
- Bruises
- bites
- burns
- lacerations
What should we know about bruises in child maltreatment?
1.Most common manifestation
2.Bruses in varying stages of healing
Where might accidental bruising locations be located?
- Bony prominences- knees and elbows
- Shins
- Lower arms
- Under the chin
- Forehead
Usually minor and small
Where might a non-accidental bruise be located?
- Upper arms
- Trunk
- Upper anterior legs
- Sides of face
- Ears and neck
- Genitalia and buttocks
Why is age important with bruises?
Less than 4 month the saying goes… those who don’t cruise rarely bruise
What amount of bruises is considered suspicious?
4-5 bruises
What should we know about the pattern of bruises that indicate child maltreatment?
- Grap marks or fingertip bruises (faces, extremeties, and thorax)
- Slap mark/handprints
- Pinch marks which are often in occult areas-behind ears, on genitalia
- loop marks
- intstrumetns
True or false: Symmetrical brusises can indicate child maltreatment?
True
What are binding bruises?
Result from being tied with an object such as an electrical cord, rope, belt etc.
What should we know about bite marks and child maltreatment?
- Forensic implications:
- Adult canine-to canine distance is >3cm (between the two dracula teeth)
What should we know about burn in child maltreatment?
- Time of immersion/Water tempertaure
- Recommended to lower the water heater to 120
What are some accidental burn patterns?
- Splash pattern: Anterior surfaces/tapering pattern
- Object burns – Palms, soles, forearms
What are some nonaccidnetal burn patterns?
- Foced immersion burns
- Extremity immersion – glove like
- Trunk immersion — donut pattern
- Pattern (object burns)
- Iron
- curling iron
- cigarette burns
What are some suspicious lacerations?
- Frenulum of upper lip
- Rectal area
- Vaginal area
What are some suspicious skeletal fractures?
- May be single or multiple
- New or old or a combination of age fractures
- Femur (less than 1 year)
- Rib (esp. bilaterally)
- Scapular
- Sternal
- Skull
- Humerus (less than 3 years)
What are some suspicious types of fractures?
- Spiral fractures– twisting/pulling
- Metaphyseal fractures– Twisting/pulling/yanking
What should we know about corner/bucket handle fracture?
Characteristic corner bucket handle fractures (metaphyseal corner fractures)
1. Mechanism: twisting injury w/consequent separation of the corner piece of the metaphysis from the remaineder of the bone
2. Caused by shaking type injury (an adult may grab, twist, or shake a childs limb in frustration)
What should we know about abdominal injuires in regards to child maltreatment?
- Second most common cause of death in child abuse cases
- Usually secondary to direct blow
- Rarely see brusies
- Injuries can include
- Ruptured liver, spleen, bladder, intestinal perforation, pancreatic injuries, etc
What are some suspicious abdominal injuries?
Injury inconsistent with history
deley in seeking care
What is the color order of bruises?
- red
- blue/black
- green
- yellow
goes away
What should we know about head injuries and child maltreatment?
- Most common cause of death in child abuse cases
What are types of external head injuries?
- Ear boxing
- Periorbital injuries
- Traumatic alopecia
What are different types of head injuries?
- External head injuries
- Skull fractures
- Intracranial injuries
What are some types of intracrainal head injuries?
- Subdural/Subaracnoid hemmorrhages
- Retinal hemorrhages
What is a type of abusive head trauma?
Shaken baby syndrome
What is shaken baby syndrome?
- Serious form of physical abuse caused by violent shaking of infants and young children
- Violent shaking causes the brain to rotate within the skull, resulting in torn blood vessels and neurons
- Large head to body ratio
- weak neck muscles
- Large amounths of water in the brain
aka
Inflicted head injury
Neuro-inflicted brain injury
What are s/s of shaken baby syndrome?
- Poor feeding
- Vomiting
- Irritabilty
- Listlessness
- seizures
- Posturing
- Apnea
- bradycardia
- Alterations in LOC
What are charcteristics injuries of abusive head trauma/shaken baby syndrome?
- Intracranial bleeding (subdural & subaracnoid hematomas)
- Bilateral retinal hemorrhages (80% of cases)
- May also include fractures of the ribs and long bones
- Most often, there are no signs of external injury
What are common triggers for shaken baby syndrome?
- Crying
- Maternal stress or depression
What can you do to reduce abuse related to triggers of shaken baby sydnrome?
Anticipatory guidance about how to care for infants with inconsolable crying
Use acronym PURPLE
What is purple crying
P: Peak pattern: crying peaks around 2 months, then decreases
U: Unpredictable: Crying for long periods can come and go for no reason
R: Reistant to soothing: THe baby may keep crying for long periods
P: Pain-like Look on faces
L: Long bouts of crying: Crying can go on for hours
E: Evening crying: Baby cries more in the afternoon and evening.
What is munchausen syndrome by proxy (MSBP) or medical child abuse or factitious disorder by proxy?
The caregiver (usually the mother with some degree of health care knowledge and training) deliberately exaggerates or fabricates histories and symptoms or induces symptoms. The caregiver is ofen very attentive to the child and may refuse to leave them
With Munchausen’s syndrome the caregiver may?
1
- Fabricate lie
- Induce Illnesss
- Be the only one who sees the signs/symptoms
Common symptoms of munchausen’s syndrome include?
- Seizures
- N/V
- Diarrhea
- Altered mental status
Why is munchausen’s syndrome by proxy considered child maltreatment?
- The child endures painful and unnecessary medical testing and procedures
How do you diagnosis munchausen’s syndrome?
The resolution of symptoms after seperation from the perpetrator, confirms the diagnosis
What are some exmaples that someone suffering from munchausen’s syndrome may do?
- May give drugs or poision to the child
- May suffocate them to cause seizures
- May give large doses of laxatives to cause diarrhea
- Mothers have been known to inject feces or light fluid in their childres iv lines..
How to respond if a child reveals abuse or neglect
List the do’s
DO:
1. Remain clam w/oout an expressive reaction
2. Believe the child (kids rarely lie if they tell)
3. Be supportive, not sympathetic
4. Allow the child to talk
5. Show interest and concern
6. Reassure and support the childs feeligns
7. Document all statement verbatim with quatation marks
8. Talk in a private place
9. Use their vocab to describe body parts
10. Take action– you could save the childs life
What are some health issues and or practices mimicking maltreatment/ abuse
- cultural practices
- Cupping/coining
- mangolian spots
- SIDS
- Osteogenisis imperfecta: BBD
- Congenital anomalies of genitalia
- Erythema multiform or Phytophotdermatites: Significant rash on trunk… looks like burns
- Idiopathic thrombocytopenic purpura (ITP) or hemophilia
- Henoch schonlein purura (HSP)
- Leukemia
- Accidnetal straddle injuries
How to respond if a child reveals abuse or neglect…. list the don’ts
DONT
1. Promise not to tell or anything you cant control
- I can’t promise you that, but I can promise you that I am going to get you some help
2. Panic or overreact
3. Do not express shock or critize their family
4. Pressure the child to talk
5. Confront the offender
6. Minimize the child’s feelings
7. Overwhelm the child with questions
What treatment can we provide for children who have gone through maltreatment?
- Trauma-focused cognitive behavior therapy (CBT)
- Helps a child who has been abused to better manage distressing feelings and to deal with trauma- related memories
- Child-parent psychotherapy
- Focuses on improving the parent-child relationship and on building on stronger atachment between the two.
What should you do if you suspect abuse?
- Document hisotry (who said what in quotes)
- Document physical findings
- Drawing and photo-documentation
- Report to CPS (consider law enformaent report as well
- Consider hospital admission for child’s safety
Who reports child maltreatment
- Anyone who suspects child abuse or neglect should report it within 48 hours
- Nurses are mandatory reporters
- A person making the report is immune from civil or ciminal liability provided the report is made in good faith
- **The priority is to remove the child from an abusive situaiton to prevent futther injury? **
How do you report abuse?
Texas abuse/neglect hotline
What information will you need to provide when you report abuse?
- Name, age & address of the child
- Your name & contact information
- Description of the situation
- Child’s current condition
- ANy information that will help identify or locate the child
