Child Abuse

Question 1

Name the 4 broad categories of child abuse.

Answer 1

1. Physical injury -> bruises, scratches, burns, fractures. 2. Sexual abuse -> behaviour change, physical symptoms e.g. bleeding, STI, pregnancy.
2. Emotional abuse -> relationships high in criticism and low in warmth.
3. Neglect -> care that does not meet the needs of a child.

Question 2

How would you manage a child whom you suspect is a victim of child abuse?

Answer 2

• Thorough history - ensure good documentation, are there any discrepancies?
• Examination - use body charts.
• FBC, clotting, swabs, bone profile, skeletal survey.
• Social services assessment +/- police input.

Question 3

What features point towards child abuse?

Answer 3

story inconsistent with injuries
repeated attendances at A&E departments
late presentation
child with a frightened, withdrawn appearance - ‘frozen watchfulness’

Question 4

What are the physical presentations of child abuse?

Answer 4

Bruising
Fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing
Torn frenulum: e.g. from forcing a bottle into a child’s mouth
Burns or scalds
Failure to thrive
Sexually transmitted infections e.g. Chlamydia, Gonorrhoea, Trichomonas

Question 5

What are features which may present in a sexually abused child?

Answer 5

1. pregnancy
2. sexually transmitted infections, recurrent UTIs
3. sexually precocious behaviour
4. anal fissure, bruising
5. reflex anal dilatation
6. enuresis and encopresis
7. behavioural problems, self-harm
8. recurrent symptoms e.g. headaches, abdominal pain

Question 6

What are the most common fractures associated with child abuse?

Answer 6

• Radial
• Humeral
• Femoral

Question 7

What are the most common fractures in paediatrics not associated with NAI?

Answer 7

• Distal radial
• Elbow
• Clavicular
• Tibial