Psychosocial, Ethical, and Legal Aspects

Question 1

What is the role of a doctor in supporting families?

Answer 1

1) Partner families to foster positive physical emotional development
- identify risk and protective factors
- give counselling/ anticipatory guidance
- introduce appropriate support/ resources

2) Be child’s advocate
- Assent, consent
- confidentiality, autonomy

Question 2

What are the 3 major causes of morbidity and mortality in adolescents?

Answer 2

1) (Un)intentional injuries
2) Mood disorders
3) Eating disorders
4) STD
5) Unwanted pregnancy
6) Substance abuse
7) Gaming/ internet addiction

Question 3

What is the HEADDSSS screening tool?

Answer 3

Home/ Housing
Education/ Employment
Activities
Drugs/ Dieting
Sexuality
Suicide/ Depression
Safety

Question 4

What is the legal definition of a child and young person in the CYPA?

Answer 4

Child: <14
Young person: 14-16

Question 6

What is the point of CYPA?

Answer 6

Act to provide for the welfare, care, protection
and rehabilitation of children and young persons who are in need of such care, protection or
rehabilitation
- parents/ guardians primarily responsible for care and welfare
- parental guardian status can be lost if parents do not fulfil their responsibilities

Question 7

What are the effects of child abuse/ neglect on the child?

Answer 7

1) Physical disability
2) Cognitive problems
3) Social isolation
4) PTSD, depression, suicide
5) Illicit substance misuse
6) Grow up to be perpetrators/ adult victims of abuse

Question 8

What are the RFs for abuse?

Answer 8

Child-related:
1) LBW, prem, congenital defects
2) Chronic illness
3) Fussy, colicky infants
4) Difficult feeders
5) Special needs

Parent-related
6) Parents’ demands/ expectations
7) Parents abused as child
8) Use of corporal punishment
9) Poverty, single-parent household
10) Social isolation
11) Alcohol/ substance abuse

Question 9

What are some signs suggestive of abuse?

Answer 9

1) Behavioural change, listlessness
2) Afraid to go home
3) Developmental regression
4) Antisocial behaviour
5) Substance abuse, delinquency
6) Physical and sexual acting-out behaviours
7) Injuries unexplained by Hx/ changing of Hx
8) Unwitnessed injuries
9) Head injury/ fractures in pre-ambulatory children
10) Suspicious/ unusual patterns of injuries
11) STI in prepubertal child/ teen pregnancy
12) Delay in seeking help

Question 10

What are the sequelae of shaken baby syndrome?

Answer 10

1) SDH
2) SAH
3) Cerebral edema
4) Parenchymal damage

Question 11

How does shaken baby syndrome present?

Answer 11

1) Irritability
2) Vomiting
3) Lethargy
4) Seizures
5) Apnea
6) Coma

Question 12

What is the most unique/ specific sign of abusive head trauma in children?

Answer 12

Retinal haemorrhages

Question 13

What are the features of fractures associated with abuse?

Answer 13

1) <18mths
2) Multiple fractures of varying age
3) Femoral, humeral (spiral/ oblique), ribs (ant and post), skull

Question 14

What are the types of child abuse and where to escalate to?

Answer 14

1) Pre-incidence/ high stress
- community agencies

2) Neglect, inappropriate discipline, inadequate medical care
- Child Protective Services, Community Agencies

3) Serious injury, severe neglect, sexual abuse
- Child Protective Services, Law Enforcement

Question 15

What are the insitutions for child support?

Answer 15

1) Home with safety plans/ community support
- extended family members
- Family Service Centers
- Childcare/ student care placements

2) Crisis shelter placements

3) Foster care

4) Institutional care
- children’s homes
- Juvenile homes
- interim placement and assessment centers

Question 16

What are the caveats to confidentiality?

Answer 16

1) Harm to self
2) Harm to others
3) Offences/ conditions reportable by law
- statutory rape
- misuse of drugs
- notifiable infectious diseases (HIV/AIDS, STIs)