Child Psychiatry: Child Abuse

Question 1

1. What are the 4 General Principles Concerning the Rights of the Child/Children

Answer 1

1. All children should not be discriminated
2. Children have a right to survival and development in all aspects of their lives
3. Best interests of the child must be a primary consideration in all decisions and actions affecting the child
4. Children should be allowed to express their Opinions

Question 2

2. The law which protects Children against

Child Abuse

Answer 2

RA 7610

Question 3

3. Known as the Child and Youth Welfare Code

Answer 3

PD 603

Question 4

4. T or F. PD 603 enumerates children’s rights and it is more comprehensive than RA 7610

Answer 4

False. PD 603 enumerates children’s rights but RA 7610 is more comprehensive.

Question 5

5. Physicians should report case of child abuse within this time period. Failure to report will held him/her liable.

Answer 5

48 – 72 Hours

Question 6

6. T or F: Failure to render immediate treatment to a child is not a form of child abuse but rather a neglect of duty

Answer 6

False. It is a form of Child Abuse.

Question 7

7. Beating your child even just once can already held you liable for abuse

Answer 7

True

Question 8

8. T or F. Physical discipline such as spanking or paddling is not considered abuse as long as it is reasonable and causes no bodily injury to the child

Answer 8

True

Question 9

9. Factors in Interviewing a child who is a victim of abuse

Answer 9

Language level, Cognitive development, Chronological (storytelling) Capacity, Reluctance to disclose

Question 10

10. T or F. Chronological and Detailed information given by the child will increase the veracity of the story and the accuracy of the incident.

Answer 10

False. Physician should doubt the veracity of the story if it is too detailed or chronological in order. One should suspect that it is a fabricated story since children are not usually capable of giving such details.

Question 11

11. T or F. Children are usually able to make associations between incidents rather than dates.

Answer 11

True.

Question 12

12. What are the DON’TS or things that physician should AVOID in conducting an interview with a child

Answer 12

1. Allowing the child to feel in trouble or at fault
2. Criticizing the child’s choice of words or language
3. Probing or pressing for answers that child seems unwilling to give
4. Suggesting an answer to the child
5. Displaying shock or disapproval of the parents, the child or the situation
6. Forcing the child to remove clothing
7. Conducting the interview with a group of interviewers
8. Leaving the child alone with a stranger

Question 13

13. What are the things that physician should DO in conducting an interview with a child

Answer 13

1. Making sure that the interviewer is someone the child trusts.
2. Conducting the Interview in private
3. Sitting next to the child and not across the table or desk
4. Asking the child to clarify words/terms that you do not understand
5. Being supportive
6. Stress that anything that happened was not the child’s fault
7. Tell the child if any future action will be required
8. Be truthful, do not make promises that you cannot keep

Question 14

14. Red Flags in the interview or assessment of child abuse

Answer 14

1. There is a discrepancy between history given and injuries sustained
2. The oral history is incompatible with the child’s development
3. The story changes or varies
4. There was unreasonable delay before seeking care
5. The parent or caretaker denies that there is an injury
6. Hostile behavior of parent/caretaker towards the child

Question 15

15. Risk Factors of Physical Abuse

Answer 15

Prematurity, Intellectual Disability and Physical Handicap

Question 16

16. Most common form of injury seen in physical abuse

Answer 16

Bruising

Question 17

17. Give example of behaviors that can be observed in physically abused children

Answer 17

1. Wary of Physical Contact
2. Show no expectation of being Comforted by Adults
3. Alert for danger
4. Continually size up the environment
5. Afraid to go home

Question 18

18. Physically abusive parents may show these following behaviors

Answer 18

1. Feel significant guilt
2. Delay seeking help for the child’s injuries
3. Fearful that the child will be taken away
4. Implausible or Incompatible history of the child’s injury with the result of physical findings
5. Blaming the sibling, or claiming that the child injured themselves
6. History of abuse in their own early lives
7. Lack of empathy for the child
8. Unrealistic expectations of the child
9. Impaired parent – child attachment

Question 19

19. A red or purple bruising which is swollen and tender to touch is a hematoma present for how long

Answer 19

0 – 48 Hours.

Question 20

20. A 2 – 3 days old hematoma will appear with this color

Answer 20

Purple or Bluish

Question 21

21. A 4 – 7 day old hematoma will most likely show this color

Answer 21

Green or Yellow.

Question 22

22. Brown colored hematoma have been present for how long

Answer 22

> 7 Days

Question 23

23. Normal Bruising Areas

Answer 23

Elbows, Knees and Shin

Question 24

24. Suspicious Bruising Areas

Answer 24

Back, Buttocks, Back of Thighs, Back of Calves

Question 25

25. Red Flags of Abusive Burns

Answer 25

1. Located in the dorsum of Hands, feet and Anogenital area 2. Repeated burns 3. Symmetric or Patterned burns 4. Uniform thickness and Clear border 5. Delay in seeking care

Question 26

26. Single burn that diminishes in intensity from point of contact

Answer 26

Splash Injury

Question 27

27 . This injury result from immersion into hot liquid or steam. Some areas of skin are spared by flexion

Answer 27

Scald Injury

Question 28

28. These are specific fractures in a child below 18 months

Answer 28

1. Metaphyseal – epiphyseal 2. Thoracic cage (Posterior Ribs) 3. Shoulder (Scapula) 4. Clavicle (Medial or Lateral) 5. Vertebral Body (from lateral compression)

Question 29

29. These are non – specific fractures

Answer 29

1. Diaphyseal shaft of long bones 2. Clavicular, Midshaft 3. Skull, Linear

Question 30

30. Highly Suggestive Fractures

Answer 30

1. Multiple, Bilateral, Symmetric 2. Repetitive, Different ages 3. Complex Skull Fracture 4. With Intracranial, visceral Injury

Question 31

31. Mechanism of Injury in Spiral Fracture

Answer 31

Twisting of the extremities

Question 32

32. This refers to different rates of hair growth. Usually result of hair pulling

Answer 32

Trichotillomania

Question 33

33. This variation of prepubertal hymen can be mistaken as an injury due to abuse

Answer 33

Fimbriated and Cribriform

Question 34

34. T or F. Vaginal discharge is specific for sexual abuse that’s why it is examined in children who are suspected to be a victim.

Answer 34

False. Not all discharges are specific for sexual abuse. It will depend on the kind of discharge

Question 35

35. If you examined a child with purulent vaginal discharge, the most probable cause would be

Answer 35

Infection (Gonorrhea)

Question 36

36. Fishy odor vaginal discharge is indicative of

Answer 36

Bacterial Vaginosis

Question 37

37. Suspicious Genital Findings

Answer 37

1. Narrow Inferior hymen (< 1mm) 2. Notch in inferior hymen 3. Local Erythema or Abrasions within vestibule 4. Presence of STI’s

Question 38

38. Genital Findings that are Clear Indications of an abuse

Answer 38

1. Complete absence of hymen down to the vaginal wall 2. Recent partial or complete transection or laceration of hymen or anus 3. Presence of sperm, gonorrhea or syphilis

Question 39

39. Genital Findings that are indicative of Chronic Abuse

Answer 39

Scarring or Attenuation of Posterior rim of Hymen, Distortion of Hymen Orifice, Scarring and adhesion of labia, lateral scarring and adhesion, redundant hymen, patulous anus and loss of sphincter tone

Question 40

40. The result of local study about abuse showed that the median age of physical abuse victims is

Answer 40

15 years

Question 41

41. Median age of sexual abuse victims

Answer 41

12.33 years

Question 42

42. Median age for perpetrators of sexual and physical abuse

Answer 42

25 years

Question 43

43. Most of the victims belonged to a family size of

Answer 43

4 – 6 children

Question 44

44. It has also been found out in this study that the frequently abused child is

Answer 44

Middle Child

Question 45

45. Most common abuser

Answer 45

Neighbors. Followed by Father of the victim

Question 46

46. A preschool children will show these signs of trauma

Answer 46

1. Fearing separation from parents or caregivers 2. Crying/Screaming a lot 3. Eating poorly and losing weight 4. Having nightmares

Question 47

47. Elementary School Children will show these signs of trauma

Answer 47

1. Becoming anxious or fearful 2. Feeling guilt or shame 3. Difficulty concentrating

Question 48

48. Middle and High School Children will show these signs of trauma

Answer 48

1. Feeling depressed or alone 2. Learning disorders and self – harming behaviors 3. Beginning to abuse alcohol and drugs 4. Becoming sexually active

Question 49

49. T or F. Emotional abuse is the most difficult to defend in the court and is the most detrimental to the child

Answer 49

True

Question 50

50. What are the components of Child abuse Accommodation Syndrome

Answer 50

Secrecy, Helplessness. Entrapment and Accommodation, Delayed Unconvincing Disclosure, Retraction of Statements