Child Abuse and Maltreatment Flashcards
Child Maltreatmnt
define
typeas
define
- abuse or neglect that happens to those undr 18
abuse
- physical
- sexual
- emotional
- medical
Neglect
most common
- phsycail
- emotiona
- educational
- medical
define
physical
sexual
emotional
medical
abuse
neglect define
Physical
- any nonaccidental injury physically to child
- burning, kickc, biting, striking
- any action = physcial impairment
Sexual
- getting an immature child to partake in sexual activities they dont comprhend
- cannot give consent to
- activity that violates the law or tabo of society
emotional
- damage to the psychological state or emotional stability of a child
- results in significant changes to theri behavior, emotional response or cogntion
Medical
- caregiver seeks inapproritaer and unnecessary medical attention for child
- creating or stiulation symptoms of illness
negelect
- any action or failure to act which puts serious physical or emotional harm/death
- puts child at imminet risk for hamr
highers rates of maltreatment = thsoe under 3
Parental Risk Factors for abuse
child risk factors
Parent
- subsance used
- impractical expecations
- younger age
- lower ses
- single parent
- limitied knowledge of child development
- personl hx. of abuse
- DV in home
Child
failure to thrive
intellecutal disability
chronic disease
meantl healht disorder
unplnaned or unwanted
premature
when to suspect and evaulte
Triage for Abuse
Mandated reporting
anytime…
- suspscious of abuse in any child
- phsycialsymptoms or GU problems
- hisotry of pain, injury or imossible trauma
Triage
- gather inforamtion and documnet all pertinents
- determine safety and welfate of child
- determine who should examine child: get bigger team invovled
- determine mandated reports!!!
Evaluation options
- emergent = to ER
- urgent: evaulte in officr rn
- eval. at later date
Mandated Reporters: PAs!!!
- professionals, teachers, etc.
- must report abuse for any suspicious under 18 years olr
- must report abuse for any suspicous over 18 but has disability
- whenever someone legally responsible reports to you from a personal knowledge, that if true, would be abuse
- when child reports
- when reasonable cause to suspect someone is abusing child
Physical Abuse
History
PE
History
- absent hx. about injury
- delayed seeking care
- histroy doesnt flow
- imprbable
- severe injury blamed on child
PE : examin head to toe
- scalp and fontanels
- ears, oral cavitiy (lingual frenula)
- fold of neck
- butt genitals
- palms and soles
Physcial Abuse: Skin/Soft TIssue
Skin/soft tissue
- biting ( > 3 cm between canine = adult)
- brusing
- burns
- frenulum tears (force fed)
- unexaplined oral injury : lip lac, tongue lac, brusing naywhere inside mouth, teeth fx. jaw fx. corners of mouth (gagging)
Brusing
- patterned brusies : related to objects
- mutliple on different areas
- infants with brusies: theyre not walking and bumping
- location: toros, ear, neck, butt
Physical abuse: Burns
Burns
- Scald burns: most common: due to immersion in hot tap water
Signs
- infants with burns
- absent hx. or inconsistent
- other injuries
- characteritis pattner: sharp line between burn and good skin
- burn patterns: of the objects (lighters, cigarettes)
pearls
- sharp line
- stocking/glove pattern
- bilateral
Physcial Abuse: fractures
Fractures
- young age ( < 1= 50% are abuse related)
- fracture in kids who dont walk
- multipelfx. with different healing
- acute bilateral long bone fractrues
Types
-rib fractures posteriorly : compressive force & see chest wall deformities+/- crepitus
spiar fraction in non-walking child
Metaphyseal corner: foricable grabbing, pulling, twising will shear off a corner of the knee or elbow or wrist bucket handle fracture
Transverse Fracture
- MC type of long bone fracture assocaited with abuse
- complete trasnverse break of humerus or femur
Spiral Fracture
- twisting motion creates this (from pulling)
Physical Abuse: Head Trauma
MCC of traumatic death and disability in fancy and childhood
- seen with retinal hemorrhages
- occuring in those < 1
symptoms
- asymptomic
- obvious
- irriatbile or poor feeding
- apnea/seizures
- alwasy ruel out accidental birth trauma
Red flags
- assoicated fractures
- retinal hemorrhage
- any skull fracture
- brusing of ears, neck or torso
Physical Abuse: head Trauma
Types
Types
Subgaleal hematoma
- hair pulling creates this
- space OUTSIDE skull between skull and scalp
Skull Fracture
- results due to a blow to skull
- linear = wide area
- depressed = significant force, smaller & underlying brain damange
- racoon eyes or battle signs (behind ears)
- visual deformity, AMS, CN issues, tender and swelling
Intercrainal njuries
- due to shaking or impact to skull
- can be hemorrhage, edmea or infarction
- epidural: LOC, regain then LOC: football convex on CT
- Subdural: (strong association iwth abuse) creaseant, concave shape on CT
- subacrachnoid: into the spaces between the brina: starburst pattern on CT
Cerebral Edema
- lack of sulci on imaging or ventricles
Retinal Hemorrhage
- without a clotting diroder: in kids this is RED FLAG for abuse
PHysical Abuse: Visceral Trauma
Abdomen
Abdomen
- second leasing cause of death in abused kids
- < 3 years old
- liver and small bowel are most common
- mutiple organ injuries = think abuse
- duodenal injuries are highly suspicous for abuse due to a direct blow
Symptoms
- brusing on abd. vomiting, poor feeding, pertinitis, distension
abuse to colon, rectal and anal are associted with sexual abuse
- due to penitrations > blunt force
- needing surgery usually
Physical Abuse: Visceral
Thorax
espohageal injuries
- due to forceful inserting a FB inot the thraot
symptoms
hematemisis
gaggibg, chicking fever, respiratory distress
Cardio and Pulm
- rare
- pulm: PTX due to rib fracture
- cardiac: rupture- due to compression between bones or ratal arrythmia due to blow to chest
Sexual Abuse includes what
presentation
Includes
- fondling
- oral-gential-anal contact
- all forms of penetration
- exhibitionsim
- exploitation
- prostituaion
- pronogrpahy
Presentation
- child with acute complaint (vagianl bleed,etc.)
- findings on exam suggest
- paretn or child says
- CPS
- child will have sexual knowldgethey shouldner
- child will abuse other child
- school probelms, subsatnce use, sexual dysfunction
Sexual Abuse
Behavior changes and medical Chagnes
Behvaior
- sleep issues
- appeitie issues
- depression anxiety social withdrawl
- aggression
- impulsive
- conduct disorder
- guilty
- suicidal or runaway
- excessive masterbation
medical concerns
- recurren abd. pain
- requent smatic plain
- gential/anal traum
- enuresis
- STIS
- pregnant
Sexual ABuse
PE
PE Findings
- injjury in GU area
- deep nothed in hymen
- lac of hymen : posterior
- absent, blueish r scarring of hymen
- abrasion or brusing of genitals
- warts or STIs
- anal dialtion
- perianca. lac.
