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Pediatric Abuse

Pediatric Child Abuse

How is child abuse or ngelect defined in federal law any recent act or failure to act by a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse or exploitation. An act or failure to act which presents an imminent risk of serious harm
What must occur for an act to fall into the category of child abuse the perpetrator is always an adult, the victim is always a child, there is a relationship between that adult and that child of custodial responsibility
What are the major types of child abuse and neglect? neglect, physical abuse, sexual abuse, emotional abuse
what is neglect Physical: lack of basic necessities (food, shelter, clothing, supervision), emotional, medical, educational
what is physical abuse? Physical injury. consider abuse regardless of intent to harm
Sexual abuse? fondling, penetration, incest, rape, exploitation
What is emotional abuse? pattern of behavior that impairs a child's self worth or emotional development. Includes constant criticism, threats, rejection, withholding of love/support/guidance
who are mandated reporters? Varies by state, HCP are always mandated reporters regardless of state
What are the red flags of abuse? cutaneous injury is the most comon sign of physical abuse. Unusual shapes, numbers, locations. Lack of reasonable explanation, changing or vauge hx, hx inconsistent with injury, inappropriate level of concern.
Where would you most likely find intential injuries Trunk, buttocks/low back, eyes, ear lobes, scalp, genitals, upper arms, ankles/feet/wrists
Where would you most likely find accidental injuries shins, elbows, knees
Bruises dating of bruises is controversial. document: mongolian spots, bruises, different colors
Phytophotodermatitis caused by certain plants/juices and then exposure to sun, most cases occur with fruti juices, parsley, parsnips,, chemical in the food that reacts with sunligh causing a blistering bruised appearance
Bites adult bite marks are diagnostic if the psace between the canine teeth marks is >3cm
Burns skip marks are a good indication that burn was accidental, suspect burn that crosses planes of the body, sharply demarcated or circumferential burns (sock),
Head injury shaken baby syndrome, skull fractures, most common cause of child abuse related deaths
Internal injry injury might not be visible, internal injury 2nd leading cause of death in child abuse cases
Skeletal damage unexplaine fracutre is always case for investigation, spiral fx in long bones of children who are not walking, chip fx at end of long bones, multi rib fx, sternal/scapulr fx, healing or healed fx revealed by xray, mult fx in diff stages,
DDX Bruises: accidental injuries, mongolian spots, allergic shiners, bleeding disorders, cultural practices. Burns: impetigo, scalded skin syndrome, FX: osteogenesis imperfecta, neoplasms
diagnostic studies Coagulation studies, serum Ca, phosphorus, Xray, bone scan, MRI ulstrasound. Depends on the kind of abuse you suspect
signs of sexual abuse Fearful behavior (nightmares, depression, unusual fears, attempts to run away) abd pain enuresis UTI genital pain or bleeding, penile warts STD extreme sexual behavior
signs of STD's confirmation of gonorrhea or shyphils is always abuse. All other stds can be transmitted nonsexulally (still should be reported)
Signs of emotional abuse change in self-confidence, HA, stomach ache, nightmares, attempts to run away
Management of child abuse case thorough H&P, consider differentials, report suspicions, carefully docuemtn findings, refer as indicated
What should be part of the Hx who lives with the child, mian caregiver, support systems, childcare arroangements, is family isolated, communication/transprotation, financial situation, education level, parenting skills, developmental expectations, safe in home, child's health, injurie
How do you prevent child abuse identify children at risk, screening, patient education
Created by: lknightly