Exam 2 - Child Abuse Flashcards
(29 cards)
What is the most common cause of lethal child abuse?
Abusive head trauma
In what age group does child abuse most often occur?
< 3 years of age
In what age group does the majority of deaths from child abuse occur in?
< 12 months of age
What are the four categories of child abuse?
Which category is most common?
- Physical
- Neglect
- Sexual
- Emotional
Neglect is most common
What are characteristics of unintentional bruising versus inflicted/intentional bruising?
Unintentional:
- Located on bone prominences such as forehead, knees, front of body (places you expect people to hit when falling)
Inflicted:
- Central bruising (buttocks, back, trunk, inner thighs, neck, ears)
- Multiple bruises in clusters
- Human bite marks
- Bruising in babies that are not independently mobile, or < 6 months
Bruising in what part of the body should cause a high level of suspicion?
Facial bruising
How can you differentiate a bite from a child versus an adult?
Due to distance between maxillary inter-canines which is 2.5-3 cm in an adult
When should you suspect possible abuse in a child with a burn?
Scalds in children < 5 years without unintentional spill pattern
What is the second most common injury in physical abuse?
Fractures
What are some fractures of high suspicion?
- Rib fractures in babies, especially < 1 year
- Long bone fractures in non-walking children
- Multiple fractures in various stages of healing
- Depressed skull fractures
Which type of intracranial bleed occurs more often in unintentional head trauma?
Epidural hemorrhage
Which type of intracranial bleed is present in nearly all fatal inflicted head traumas?
Subarachnoid hemorrhage
What is frequently seen on eye examination in a child with abusive head trauma?
Retinal hemorrhage
Which type of skull fracture should abuse be suspected in?
More complex, depressed skull fractures
What are other possible differentials other than abuse in a child that presents with bruising?
- Salicylate ingestion
- Mongolian spots
- Coagulopathy
- Vasculitis
What is an exam finding that can help you differentiate bruising due to abuse from Mongolian spots?
Mongolian spots will have absence of swelling or tenderness and typically are limited to the back and buttocks
What is one exam finding that can help you differentiate bruising due to abuse from vasculitis?
Vasculitis will have a purpuric rash and lesions
What are other possible differentials other than abuse in a child that presents with fractures?
- Osteogenesis imperfecta
- Nutritional deficiencies
- Pathologic/Neoplasm
What are other possible differentials other than abuse in a child that presents with burns?
- Unintentional
- Impetigo
- Phytophotodermatitis
What is one exam finding that can help you differentiate burns due to cigarettes burns from impetigo?
Cigarette burns are typically more defined, third degree, and heal with scarring while impetigo is only the superficial layer
What is the primary study that you should order if concerned for skull fracture?
Non-contrast CT
What is the primary study that you should order if concerned for spinal fracture?
CT with contrast/MRI for nerve root or spinal cord injury
What is the primary study that you should order if concerned for thoracic injury?
CT with contrast
What is the primary study that you should order if concerned for abdominal injury?
CT with contrast
