Flashcards in Child Abuse Deck (20)
What are normal variants of anogenital findings?
1.Hymenal notches or transection in anterior half
2. Genitoanal erythema
3. Perianal skin tags
4. Midline anal fissures
5. Anal dilatation
What genital/anal findings are consistent with trauma suggestive of sexual abuse?
1. Acute: perineum laceration or bruising
2. Nonacute: Complete transection of hymen in posterior (3 to 9o'clock position)
3. Anal dilation >20mm without stool
4. Non-midline anal lesions
What is the most common physical exam finding of sexual abuse?
Normal physical exam (95%)
The most common head injury from abusive trauma is:
True/false: daytime institution increases risk of sexual abuse in chronic/disabled children.
What 6 fractures are suggestive of abuse?
Vertebral (spinous processes)
Classic metaphyseal lesions (bucket/corner)
(less indicative: epiphyseal separation, digital fractures, multiple fractures, fractures of different ages)
List the risk factors for child abuse.
Child: congenital anomaly, delay/disabilities, failure to thrive, ADHD with hyperactivity, unwanted child, prematurity
Environment: low SES, social isolation, family stressor, domestic violence, unrelated adult in the household
Caregiver: young parents, low education in parents, parental substance abuse, parental psychiatric illness
What is the timeframe of efficacy with postcoital contraceptive?
Most effective within 72h, can work up to 120h (5d)
What can help prevent child abuse?
1. Nurse home visit
2. Parenting class
What are the three most diagnostic STD for sexual abuse in children?
Syphillis, HIV, gonorrhea
What can cause retinal hemorrhage?
Trauma (accidental/NAI), birthing (SVD, AVD, C/S), other illnesses (sepsis, inflammatory). Usually NOT CPR.
What are the worrisome features for burns?
Symmetrical burns, lower extremities/perineum, >10% BSA, sharp demarcation, stun gun/cigarette burns, full thickness burns
The age of consent for sexual activity is:
16 years, but when "exploitive" then 18 years
What is the age gap for consent to sexual activity for 14 and 15 y.o.?
5 years (unless they are married to each other) and non exploitive
What is the age gap for consent to sexual activity for 12 and 13 y.o.?
2 years and non exploitive
greatest risk factor for child maltreatment (caregiver characteristic)
caregiver is a victim of domestic violence
"red flags" for bruising
patterned, bilateral/symmetrical, unusually large/numerous, do not fit mechanism of injury, location (axial, ears, genitals, any soft padded places), non-mobile child
fracture locations that are more specific for abuse
ribs, long-bone metaphases, scapula, sternum, vertebral spinous processes
what is a sentinel injury?
a minor injury that is externally visible to health care providers (most common = bruising)