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Peds Exam 2

Child Maltreatment

QuestionAnswer
what is child maltreatment Neglect / Abandonment Abuse
Neglect / Abandonment Most common Physical or emotional
Abuse Physical; deliberate infliction of physical injury Psychological - Emotional Sexual
neglect: physical Deprivation -food, clothing, shelter, supervision, medical care and education Not meeting basic level of care - not due to money but intentionally so consider circumstances
neglect: emotional Failure to meet child’s need for affection, attention and emotional nurturance
what type of neglect is very hard to prove emotional
what could neglect look like not sending child to school, being okay with child doing drugs a lot of times one parent is physically abusive and one parent is emotionally neglectful
Child Maltreatment- Abuse
 Deliberate harm: Physical Emotional Sexual
physical abuse aka non accidental trauma (NAT)
non accidental trauma is Deliberate infliction of physical injury, usually by caregiver and is common in nonbiological families (typically mom's boyfriend)
non accidental trauma can be suggested by Pattern of injury more suggestive than type of injury Incompatible story and injury Inconsistent stories
Pattern of injury more suggestive than type of injury Injuries to face, neck, genitals, buttocks, back Patterned burns - same object being used Spiral fractures Dislocations Injury could have been avoided
if there is a bruise on an infant, there is a story behind it!!
Abusive Head Trauma (AHT) aka shaken baby syndrome
AHT is caused by Violent shaking of infants and young children, generally out of frustration
AHT in infants because Infants have a large head-to-body ratio, weak neck muscles, and a large amount of water in the brain
in AHT, violent shaking causes brain to rotate within the skull
what make an infant with AHT have Retinal hemorrhages (always think abuse!!) Rib fractures (if squeezed hard enough)
nurses have an active role in prevention of AHT inform them that they WILL be frustrated, they should just put baby in a safe place (crib) and take a few minutes and then return
Factitious Disorder Imposed on Another (FDIA)
aka Munchausen Syndrome by Proxy, Medical Child Abuse

FDIA is when Caregiver exaggerates/fabricates histories and symptoms or induces symptoms in a child
FDIA perpetrator Psychiatric condition in perpetrator and child becomes victim Pathological desire for attention
in FDIA, Perpetrator is the only witness to symptoms Child endures painful and unnecessary medical testing and procedures
who often is a perpetrator in FDIA women with some medical knowledge
detecting victims of FDIA Is condition consistent with reported history? Does diagnostic evidence support reported history? Has anyone other than caregiver witness symptoms? Is treatment being provided primarily because of caregiver’s demands?
identification of child maltreatment identification is KEY!! History/Interview Physical examination: skeletal survey Documentation!!! so important!!!
Physical examination: skeletal survey when suspecting maltreatment evaluate the whole body are there different stages of healing? suggests repetitive event
red flags in child maltreatment Injury doesn’t match mechanism Inconsistent story Bruises in different stages of healing and in atypical areas Fractures in different stages of healing
Intervention for Child Maltreatment Nurses are “mandated reporters” Protect child from further abuse - safety plan Evaluate risk for other children in home Support for child and family
safety plan for maltreatment child stays in hospital/safe environment until they can send them to a safe environment
Evaluate risk for other children in home often times if one child is abused and that child is removed, abuser will pick the next victim
Support for child and family Child values relationship with abusive parent(s) Address physical, developmental, and play needs
Created by: leh195
 

 



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