Child Abuse and Child Sexual Abuse Flashcards
Define child abuse
The act of harm to a child by parent, relative, sibling, carer or other person
Child treated by adult in a way that is unacceptable in given culture
Define child sexual abuse
Sexually immature children participate in sexual activities they do not fully understand, to which they are unable to give informed consent and that violates social taboos of family roles
Types of child abuse
Physical - non-accidental injury Sexual Emotional - psychological Neglect - not necessarily deliberate - may not have intelligence, time and resources to give to children
Statistics of child abuse
100 children die every year
75% offenders known to victim
Child abuser features
Most male Often abused themselves May abuse many different victims Abuse may occur over long periods May target both boys and girls Often work and live near children Have position of trust
Common social factors of child abuse
Child often abused by close relative Family tends to be low income group Family often insecure or unstable Hx of social problems in abusers Hx of psychiatric problems
Typical victim of child sexual abuse
Less than 2 years old - unable to stand up or report Boys more frequent Child often first born Child often illegitimate Unplanned or unwanted pregnancy Congenital defect or abnormality
Problems with diagnosing child abuse
Underdiagnosis - late or missed - escalating abuse can lead to death of child - public outrage Overdiagnosis - infringes rights of family - public outrage Correct diagnosis is difficult
Ethical considerations when exanimating a child
Patient autonomy
- patient/parent/guardians’ right to self determination
- make their own informed choices
Beneficence
- Dr must act in patient’s best interests
Non-maleficence
- first do no harm
Justice - Dr must be balance, fair and non-judgemental
Fully informed consent requires
Disclosure
- Dr must supply patient with all necessary info to make autonomous decision
- facts, nature, benefits v limitations, alternatives
- implications and consequences
Capacity
- patient or guardian must understand
Voluntariness
- right to decide freely without undue influence, coercion or threat
Age of Legal Capacity (Scotland) Act 1991
Person under the age of 16 shall have legal capacity to consent to surgical, medical or dental procedure or treatment
Where in the opinion of a qualified medical practitioner they are capable of understanding the nature and possible consequences of procedure or treatment
Patterns of injury in child abuse
Bruising - multiple ages - fingertips - difficult to explain - mouth, lips ears Biting - pets may bite child - human bit more circular - may be from other children Burning and scalding - round cigarette burns - multiple thermal burns Fractures - multiple and varying age - skull, ribs, long bones on limb - spiral x-ray appearance Internal injuries - head injury from impact or shakin - visceral injury from punching and kicking Torn frenulum of lip - from forcible feeding Hair pulling Friction burns from dragging Binding marks
Features of impact head injury
Scalp injury Skull fracture Subdural haemorrhage Cerebral oedema Diffuse axonal injury
Features of shaking head injury
No external sign Subdural haemorrhage Cerebral oedema Diffuse axonal injury Retinal haemorrhages
Visceral injury seen in child abuse
Rupture of spleen or liver
Intestinal perforation - duodenum
Mesenteric tears
