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T/F, in the US each state defines child abuse and neglect within its own civil & criminal codes.



Types of child abuse?
Who are the MC perpetrators?

-child neglect

MC perpetrators:
-biological parents


Certain children are more likely to be victims of child abuse, who are these children?

-age less than 3YO
-Past hx of abuse; 50% chance of experiencing further abuse and 10% chance of dying.
-children w/ speech/language disorders, learning disabilities, non-conduct psych problems
-children with handicaps, chronic illness
-hyperactive adopted and step children.


What is the more prevalent form of child abuse? What are the types?


Types :
-physical = food, clean clothes, basic hygiene


Medical Neglect:

-simplify care as much as possible
-give written instructions
-remove barriers to access

*may require hospitalization:
-for serious medical conditions
-to protect the child
-to observe the parent-child interaction.


What is the most commonly injured area of the body? What is the most common type of injury seen?

Oralfacial injuries:
-intraoral injuries
-fx of maxilla, mandible, or facial bones
-oropharyngeal gonorrhea or syphillis
-black eyes or basilar skull fx
-bruising or scarring corners of the mouth from being gagged
-traumatic alopecia

Bruises are MC type of injury.
- central bruising suggests abuse
-bruising in babies who are not mobile is uncommon
-ligature marks or rope burns of the neck, wrists, and ankles


DDX of bruises

*Bleeding disorders::
-bruises uniform in color
-inflicted bruises have different colors
-check clotting studies, CBC w/ platelets, PT, PTT

Salicylate ingestion

Henoch Schonlein purpura

Mongolian Spots


Clinical manifestations of abuse

-bite marks
-burns: immersion, microwave, stun gun burns, cigarette
-fractures; fx of multiple stages of healing


PE looking for what signs?

If you suspect abuse what labs/studies should you get?

-skin lesions, swelling, deformity
-bone tenderness, reluctance to use and extremity
-retinal hemorrhages (shaken baby syndrome)
-trauma to genital or mouth

-bleeding eval: CBC w/ platelets, PT, PTT
-CMP: check LFT, electrolytes, r/o bone dz
-UA: hematuria
-toxicology: inappropriate administration of medications
-skeletal survey (any child less than 2YO w/ concerning fx, abd injury or concern for head trauma)
-ophthalmologic eval


sexual assault in children definition

-when child engages in sexual activity for which he/she cannot give consent, is unprepared for developmentally, cannot comprehend, and/or an activity that violates the law or social taboos of society


Sexual abuse includes:

-forms of oral-genital, genital or anal contact with a child
-nontouching abuses:
--voyeurism: peepers
--involving the child in pornography


Is sexual play normal?

yes. Involves children separated by no more than 4 years.


Women between the ages of ___ and __ are at greatest risk of intimate partner violence.

Women between 20-34 are at greatest risk of intimate partner violence.


Children who witness intimate partner show an increase in?

-aggression and conduct disorders
-anxiety and intrusive thoughts
-disrupted sleep patterns and depression
-risky behavior


What is RADAR?

Routinely screen pts for abuse.

Ask direct questions

Document findings

Assess safety of victim and children

Review options/referrals/reportng requirements.

*Perform this on new pts, yearly, when mother or teenager is involved in a new intimate relationship or becomes pregnant.


Barriers to reporting sexual abuse?

-PCP though alternative strategies could be more effective then child protective services.

-inadequate training to recognize abuse

-cultural attitudes

-perception the CPS intervention is ineffective.


Clinical features of an emotionally abused child?

-emotional disturbances:
--anxiety, depression
--agitation, fearfulness

-Social withdrawl:
--running away from home
--developmental delay
--drug or alcohol problems
--eating disorders