Child Abuse

Question 1

What are the four types of child abuse? Which is most common?

Answer 1

• Neglect = MOST common
• Physical
• Sexual
• Emotional

Question 2

What age group is child abuse most common in?

Answer 2

<3 years

Question 3

½ of all deaths from child abuse are in children of what age group?

Answer 3

<1 year

Question 4

What type of bruise is especially suspicious for child abuse?

Answer 4

FACIAL

Question 5

Bruises of what area of the body are more likely to be unintentional (3)?

Answer 5

Bony prominences:

• Forehead
• Knees
• Anterior body

Question 6

What type of physical abuse can be associated with sexual abuse?

Answer 6

Bites

Question 7

If there is a bite mark present, what test should ALWAYS be done?

Answer 7

Swab for DNA

Question 8

How can you differentiate a child bite mark from an adult bite mark?

Answer 8

Distance between maxillary inter-canines is 2.5-3 cm for ADULTS

Question 9

What three types of orofacial injuries are commonly seen/most concerning?

Answer 9

• Frenulum tears
• Skull fractures/facial fractures
• Ear bruising

Question 10

What is the SECOND most common injury seen with physical abuse?

Answer 10

Fractures

- Often associated with other injuries

Question 11

What three types of fractures are especially suspicious for abuse, and in what populations?

Answer 11

• Rib fracture in <1 year
• Long bone fracture in non-walking
• Multiple fractures in different stages of healing

Question 12

What are the two most common types of fractures seen with abuse?

Answer 12

• Metaphyseal lesion of long bones

- Rib fractures

Question 13

What is the most common cause of lethal child abuse?

Answer 13

Abusive Head Trauma (AHT)

Question 14

What other finding is often seen with Abusive Head Trauma (AHT)?

Answer 14

Retinal hemorrhage

Question 15

Parents who seek care for localized swelling, lethargy or asxs post-injury = injury is more likely due to what?

Answer 15

Unintentional

Question 16

Parents who do NOT seek care until breathing issues, apnea, seizures, lifeless = injury is more likely due to what?

Answer 16

ABUSE

- Wait to have child seen until severe/too late

Question 17

What type of IC bleed is often due to unintentional trauma?

Answer 17

Epidural hemorrhage

Question 18

What two types of IC Bleeds are often due to AHT?

Answer 18

• Subdural hemorrhage (SHD)

- Subarachnoid hemorrhage (SAH)

Question 19

What type of IC bleed presents in almost ALL fatal causes of AHT?

Answer 19

Subarachnoid hemorrhage (SAH)

Question 20

If a patient presents with complex, depressed skull fracture, what condition should you suspect?

Answer 20

Subarachnoid hemorrhage (SAH)

Question 21

With what type of abuse is emotional or behavioral changes often seen, rather than physical?

Answer 21

Sexual abuse

• More common in females
• Males less likely to report

Question 22

What diagnostic test should always be performed if you suspect sexual abuse?

Answer 22

Collect forensic evidence (especially if within 24 hours)

Question 23

What two types of abuse involve current AND future harm (actual vs. potential)?

Answer 23

• Neglect

- Emotional

Question 24

What four differential diagnoses should you consider for bruising due to abuse?

Answer 24

• ASA ingestion = bruising
• Mongolian spots
• Vasculitis
• Coagulopathy

Question 25

In what two ways can you differentiate Mongolian spots from bruising due to abuse?

Answer 25

- Mongolian spots lack swelling or tenderness | - Mongolian spots fade over MONTHS/YEARS (not days)

Question 26

If bruising is present and there is NO witnessed abuse, what lab should you consider ordering?

Answer 26

Coagulation studies/CBC

Question 27

How can you differentiate Vasculitis from bruising due to abuse? What condition might you consider for Vasculitis?

Answer 27

HSP | - HSP is seen on LE + arthralgias, abdominal pain

Question 28

What three differential diagnoses should be considered for fractures due to abuse?

Answer 28

- OI/Brittle Bone - Nutritional deficiency - Pathologic fracture (neoplasm)

Question 29

What differential diagnosis should be considered for burns due to abuse?

Answer 29

Impetigo

Question 30

How can you differentiate Impetigo from cigarette burns due to abuse (3)?

Answer 30

Cigarette burns are... - Deeper - More defined/uniform shape - SCAR (Impetigo does not scar)

Question 31

What condition involves sensory, automatic neuropathies → decreased sensation to pain, temp.?

Answer 31

Congenital Pain Insensitivity

Question 32

What five injuries should raise HIGH suspicion for abuse?

Answer 32

- Bruises on trunk/ear/neck - Long bone fractures if non-ambulatory - Rib fractures in <1 year - Subdural hemorrhage (SHD) in <1 year - Hollow viscous injuries

Question 33

What five history components should raise HIGH suspicion for abuse?

Answer 33

- Inconsistent with injury - Change in MOI - Vague/no history - Injury blamed - History of prior bruising or orofacial injury

Question 34

What four signs of parent behavior should raise HIGH suspicion for abuse?

Answer 34

- Delay in seeking medical care - Lack of appropriate concern for injury severity - Abnormal emotions - Partial confession

Question 35

What is the recommended initial imaging? What imaging should then be performed next?

Answer 35

Initial = XRAY | - Then CT with contrast (without contrast if skull)

Question 36

Skeletal survey should be ordered if <6 months with...

Answer 36

ANY bruising except if reported fall OR single bruise

Question 37

Skeletal survey should be ordered if <9 months with...

Answer 37

1+ bruises ANY location

Question 38

Skeletal survey should be ordered if <1 year with...

Answer 38

1+ bruises not on bony prominences (cheeks, eyes, ears, neck, torso, upper arms/legs, genitals/buttock, hands/feet)

Question 39

Skeletal survey should be ordered if <2 years with...

Answer 39

4+ bruises not on bony prominences (ears, neck, torso, genitals/buttock, hands/feet)

Question 40

What two groups should always be called for abuse cases?

Answer 40

- CPS - Police Reporting is mandated in ALL 50 states

Question 41

If a patient has suffered/survived child abuse, they are at increased likelihood for what five things?

Answer 41

- Criminal activity - Teen pregnancy - Risky sexual behaviors - Substance use - Future abuse