Shared Flashcard Set

Details

Child Abuse and Neglect
Exam 3
66
Medical
Graduate
04/19/2015

Additional Medical Flashcards

 


 

Cards

Term

Injuries or illnesses that occur to children as result of family dysfunction. In practice, child abuse is considered non-accidental injury of children at the hands of their caregivers.

Physical abuse is leagally defined by state laws.

Definition
Child Abuse
Term
Types of Abuse
Definition

Physical

Sexual

Emotional

Neglect

Physical

Emotional

Medical

Term
Defined as non-accidental trauma
Definition
Physical Abuse
Term
Most often inflicted by caregiver or family member, but occasionally by stranger.
Definition
Physical Abuse
Term
Types: bruises, burns, fractures, head trauma, and abdominal injuries
Definition
Physical Abuse
Term
Defined as engaging of dependent developmentally immature children in sexual activities to which they do not understand and cannot give consent.
Definition
Sexual Abuse
Term
May involve: incest, rape, pedophilia, fondling, oral-genital-anal contact, exhibitionism, voyeurism, prostitution, pornography
Definition
Sexual Abuse
Term
Defined as rejection, ignoring, criticizing, isolation or terrorizing children  which erodes their self-esteem. Most common is verbal. Domestic violence should also be considered abuse.
Definition
Emotional Abuse
Term
Types of Neglect
Definition

Medical

Physical

Emotional

Term
Failure to provide the needed treatment to kids with life threatening illness, chronic or serious health problems
Definition
Medical Neglect
Term
Failure to provide food, clothing, safe environment. Sometimes associated with poverty or ignorance.
Definition
Physical Neglect
Term
Absence of norm parent-child attachment; failure to respond to child's needs (nutritional needs)
Definition
Emotional Neglect
Term
Unusual disorder in which the caregiver, usually the mother, either simulates or creates symptoms or signs of illness in a child either for attention or personal gain.
Definition
Munchausen Syndrome by Proxy
Term

Epidemiology:

Abuse may occur in families from any socioeconomic class, ethnicity, or community

Definition
Child Abuse
Term
Substance abuse, poverty and economic strains, parental capacity and skills, and domestic violence are most common presenting problems in abusive families
Definition
Child Abuse
Term

Epidemiology:

The recognition of child abuse physical abuse begins with the clinician's ackowledgement that child abuse occurs commonly

Definition
Child Abuse
Term

Epidemiology:

Parents who were abused as children are at a greater risk for abusing their own children. it is estimated that 30% go on to be abusive parents

Definition
Child Abuse
Term

Incidence:

Children <3- highest rates of maltreatment

In 2008, there were 3.3 million referrals to child welfare agencies in the US for child abuse and neglect

Definition
Abuse Statistics
Term

Incidence:

~702,000 children were determined to be victims of child maltreatment

The child abuse victimization rate was 9.3 per 1,000 children in the national population

Almost 1,800 abusive deaths per year, by conservative estimates

Definition
Abuse Statistics
Term
Presentations of Abuse
Definition

Difficulty walking or sitting- sexual, Physical

Failure to Thrive- neglect, physical, emotional

Depression/suicide- sexual, physical, emotional

Incidental findings on routine exam- physical, sexual

Recurrent UTI's- sexual

Poor bonding- emotional, neglect, physical

Precocious sexual behavior

Term
Family Dynamics
Definition

Parental Probelms

"Elevated Care Child"

Poor Social Support

Family Crisis

Term
A detailed history of injury is essential for comparing the mechanism provided by the historian with the injuries identified.
Definition
Physical Abuse: History
Term

Historical features that should raise the questions of ___

History provided does not correlate with findings

Child's development is not compatible with mechanism described

History of even changes with time

Unexpected delay in seeking care

No history of trauma is provided

Definition
Physical Abuse: History
Term

Disclosure that injury was inflicted

Event of behavoir by a child that triggers a loss of control by the caregiver

History of abuse in the caregiver's  childhood

Innappropriate affect of the caregiver

Pattern of increasing severity or number of injuries of no intervetion

Definition
Common historical features of Physical Abuse
Term

Social or physical isolation of the child or caregiver

Stress or crisis in the family or caregiver

Unrealistic expectations of caregiver for the child

Behavior changes of child

Definition
Common Historical Features of Physical Abuse
Term
A history that is inconsistent with the pt's injuries is the hallmark of ___
Definition
Physical Abuse
Term

Bruises on uncommonly injured body surfaces

Blunt-instrument marks or burns

Human hand marks or bite marks

Definition
Physical Indicators of Child Abuse
Term

Cigarette burns

Multiple injuries at different stages of healing

Evidence of poor care or failure to thrive

Circumferential immersion burns

Unexplained retinal hemorrhages

 

Definition
Physical Indicators of Child Abuse
Term

Assess for:

Growth failure

Bruisees

Burns

Oral injuries

Palpable rib fxs

Abdominal injuries

Genital injuries

Retinal hemorrhages

Are the findings explained by any medical condition?

Definition
Physical Abuse- Physical Exam
Term
Subdural hemorrhage is a hallmark of ___
Definition

Abusive head trauma

Associated with abuse can be located anywhere around the brain but are often found in the posterior interhemispheric fissure

Term

Bone injuries: Posterior rib fx, metaphyseal (bucket-handle or corner)

fracture, scapula, sternal, or spinous process fxs

Definition
Physical Abuse-Physical Exam
Term
Skeletal Injuries
Definition

Long bond fxs- spiral, bucket handle (metaphyseal)

Scapular fxs

Rib fxs (esp posterior)

Spinous Process fxs

Skull (esp. non-linear)

Sternal fxs

Multiple fxs

Term

Physical Abuse-Diagnostics

For children with bruising or bleeding

Definition

CBC, PLT count

Prothrombin time/partial thromboplasatin time, INR

PLT function evaulation

LFTs

Amylase, lipase

UA

Creatine kinase

LP

Toxicology screen

Term
Physical  Abuse- Imaging
Definition

Skeletal survery

Clavicle, long bone shaft and linear skull fxs are common accidental fxs that have low specificity for physical abuse

CT and MRI

Term
Management of Abuse
Definition

Report any suspicious cases to local child welfare agency

Report abuse to law enforcement when injuries warrant police investigation

Consult social worker

You, as a professional, are obligated by law to call CPS!!!

Hospitalization to ensure the protection of the child during initial investigation is sometimes necessary

Term
Involvement of children in sexual activities that they cannot understand, for which they are not developmentally prepared, to which they cannot give informed consent, and/or that violate societal norms
Definition
Sexual Abuse
Term
Incidence: 150,000 substantiated cases are identified each year in the US. Likely a significat underestimation of the actual numbers.
Definition
Sexual Abuse
Term

Epidemiology and Risk Factors:

Risk increases with multiple care takers

Children at all ages may be victimized with a peak age of vulnerability between 7 and 13 years

 

Definition
Sexual Abuse
Term

Epidemiology and Risk Factors:

Girls are victimized more than boys, although abuse of boys is thought to be underreported.

African American > Caucasian

Low socioeconomic status

Children with disabilities

Definition
Sexual Abuse
Term
Interview should be detailed anough to know whether a report to CPS or law enforcement is needed
Definition
Sexual Abuse- History
Term

History:

Should be conducted with the child separate from family members; diagnosis often depends on the history obtained from the child.

Definition
Sexual Abuse
Term

History:

Ask open-ended, non appropriate language

Special questions:

Identity of alleged perpetrator/relationship to child

Time of last possible contact

Method of disclosure

Specific types of secual contact included in the abuse

Previous official reports to the abuse

Review of systems including genital pain, bleeding, dyuria, painful bowel movements and behavior changes.

Definition
Sexual Abuse
Term

Most ___ children have normal genital examinations

Abuse may not have caused injury to tissues

Mucosal injuries heal quickly and may be resolved by the time child is examined

Definition
Sexual Abuse
Term

Prepubertal children require detailed external genital inspection only

Genital exam can be done with child in supine frog-leg position

Use of the techniques of labial separation and traction will allow complete examination of vulvar structures

Definition
Sexual Abuse
Term

Adolescent girls usually do not require a full pelvic exam

Prepubertal girls should not have a speculum exam without anesthesia

Definition
Sexual Abuse
Term
Few physical findings are diagnostic of abuse:
Definition

These include the presence of semen, acute genital/anal injuries without an adequate accidental explanatino, syphilis and N. gonorrhea

Look for acute genital injuries and marked disruptions of hymenal tissue

Term
Sexual Abuse- Diagnostics
Definition

Testing for N. gonorrhoeae and C. trachomatis

Forensic evidence collection

Term
Sexual Abuse- Management
Definition

Prophylactic antibiotics against common STI

Consider pregnancy prevention
Tetanus booster

Hep B vaccination

Sitz bath for comfort

Report!!!

Term

Prevention:

Teach children to protect themselves and their "private parts"

Definition
Sexual Abuse
Term
Absence of normal parent child attachment
Definition
Emotional Abuse and Neglect
Term
Inability to recognize or respond to infant or child's needs
Definition
Emotional Abuse and Neglect
Term
Common manifestation: nonorganic FTT
Definition
Emotional Abuse and Neglect
Term
Emotional abuse may cause non specific symptoms in children
Definition
Emotional Abuse and Neglect
Term
____ abuse can occur at home, day care, school, sports team, or other settings.
Definition
Emotional
Term
Most common form of abuse
Definition
Neglect
Term

Failure to provide necessary food, clothing, shelter and safe environment

Often associated with poverty or ignorance

Definition
Physical Neglect
Term
Failure or inability, intentionally or unintentionally to recognize and respond to the needs of a child
Definition
Emotional Neglect
Term

History:

Evaluate psychosocial history and family dynamics

Social servies evaluation of home and family

Failure to thrive/growth failure

 

Definition
Neglect
Term

Phsycial Exam:

Absence of subcutaneous fat in cheeks, buttocks, and extremities

Definition
Neglect
Term

Physical Exam:

Poor nutrient and vitamin intake manifestations

Depression

Definition
Neglect
Term

Physical Exam:

Short stature/deprivation dwarfism (in older children)

Normal head circumference

Definition
Neglect
Term

Diagnostics:

FFT work up

Assessment of growth curv

CBC, electrolyte panel, thyroid and liver function test

Skeletal survery

Definition
Neglect
Term
Failure to provide the needed treatment to infants and children with life-threatening illness or serious or chronic illness
Definition
Medical Care Neglect
Term
Medical Care Abuse:
Definition

Munchausen syndrome by proxy

Caregivers simulates or creates symptoms or signs of illness in a child

Term

Medical Care Neglect and Abuse

May present with:

Definition

SxS of whatever illness is factitiously produced or simulated

Long list of medical problems or bizarre, recurrent complaints

Persistent doctor shopping and refuse to acceptance that the child is healthy

Term

ON PE check for Signs of sexual abuse

It's your job and your responsibility

On any type of suspected abuse, it's good to get your supervising physician to check. It's always good to have a second opinion.

Good documentation

Most emergency departsment have sexual assault team, Use them!!!

 DON'T LET THE KIDS DOWN, YOUR VOICE MAY BE THEIR ONLY ESCAPE

Definition
Protect the kids
Supporting users have an ad free experience!