peds: child abuse

Question 1

5 ways to define child abuse

Answer 1

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

Question 2

4 types of child abuse

Answer 2

Physical Abuse
Sexual Abuse
Emotional Abuse
Neglect

Question 3

do you want to try to “date” a bruise (describe as old or new) ?

Answer 3

NO! only describe it

Question 4

what happens to a “shaken baby” and what are the common signs?

Answer 4

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

Question 5

abuse may results in ____ or _____ injuries

Answer 5

pattern (i.e. extension cord, boot mark, etc.)

non-obvious (i.e. lip, back of ears)

Question 6

what is a key part of the motivation behind sexual abuse?

Answer 6

the perpetrator is in a position of power or control over the victim.

Question 7

what is the ideal viewing position for sexual abuse?

Answer 7

supine frog leg

Question 8

where may gonorrhea be found in pre-pubertal pts?

Answer 8

pre-pubertal: endocervical tissue, urethra and vagina in pre pubertal patients

Question 9

dx of gonorrhea for post-puberty, sexually active pts?

Answer 9

Post pubertal patients who are sexually active, diagnosis (of abuse) may be hard to determine abuse verses from consensual intercourse

Question 10

chlamydia: adolescents may be asymptomatic for ___ years.

Answer 10

3

Question 11

chlamydia Infects the _______ ______tissue in adolescents

Answer 11

epithelium endocervix

Question 12

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.

Answer 12

50-75%
1
Presence of Chlamydia after age 1 with no positive history from mom, considered highly suspicious

Question 13

gonorrhea txt:

chlamydia txt:

Answer 13

GC: rochephin
chlamydia: azithroymycin + doxycycline

Question 14

trichomonas txt:

Answer 14

flagyl

Question 15

how is trichomonas transmitted? more often in abuse cases of teens or children?

Answer 15

• 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

Question 16

is a child doesn’t show up with HPV at birth (from mom) but rather at __ - __ yo, it is a sign for abuse?

Answer 16

3-4 yo

Question 17

defining characteristics of emotional abuse (what do the abusers do?)

Answer 17

Abusers constantly reject, ignore, belittle, dominate and criticize the victims.

Question 18

signs of emotional abuse: child (weeds)

Answer 18

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

Question 19

signs of emotional abuse: parent (weeds)

Answer 19

• 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

Question 20

signs of emotional abuse: child and parent (Weeds)

Answer 20

Rarely touch or look at each other
Consider their relationship entirely negative
State that they do not like each other

Question 21

“withholding of medical treatment or nutrition from disabled infants with life-threatening conditions” is what? .

Answer 21

medical neglect

Question 22

__-__% of reports of abuse by a child are false. why is this significant?

Answer 22

2-5%

believe the child when they report it!

Question 23

On average a child will disclose more than __times before he or she is taken seriously. who is this reporting to mostly?

Answer 23

5 times

mostly when telling the parents… are they are reporting to them more than anyone

Question 24

Often if there is more than one child in the home…

Answer 24

the other children are probably being abused also.

Question 25

3 dermatology issues that can mimic abuse

Answer 25

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

Question 26

2 non-abuse injuries that can mimic abuse

Answer 26

Straddle Injuries:
History is the key
(fell on a toy)

Labial Adhesions:
Most common under 2 years of age.
Thin Translucent line

Question 27

what is “coining” ?

Answer 27

Long standing Asian fold remedy, special oil is applied to a coin and stroked in a pattern

Question 28

what are “mongolian spots”

Answer 28

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

Question 29

emergency care for abuse: how can you “gain entry” with the child?

Answer 29

low tone voice and assure them you are their to help

Question 30

emergency care for abuse: what are some key things to remember when dealing with the child, getting their story?

Answer 30

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!

Question 31

emergency care for abuse: PE of child

Answer 31

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.

Question 32

do not ask the caregiver…

Answer 32

DO NOT ASK THE CAREGIVER ABOUT ABUSE OR ACT ACCUSATORY TO THE CAREGIVER.

Question 33

document everything but be _______

Answer 33

objective!

Question 34

why is mandatory reporting important especially pertaining to VA laws?

Answer 34

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

Question 35

Mandated reporters who fail to report suspected child abuse or neglect, within __ hours of first suspicion, can be charged with a ______

Answer 35

72 hours

misdemeanor

Question 36

mandated reporter: if found guilty of failing to report what is the cost for the first and any following incidents?

Answer 36

the fine is up to $500 for the first incident, and from $500-$1,000 for any subsequent incidents

Question 37

signs of compassion fatigue syndrome

Answer 37

withdrawal, overwhelmed feeling, fatigue, inability to enjoy life, inappropriate anger, may feel inadequate, in over your head, want out