Pediatric Child Abuse
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| 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
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| 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
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| What are the major types of child abuse and neglect? | neglect, physical abuse, sexual abuse, emotional abuse
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| what is neglect | Physical: lack of basic necessities (food, shelter, clothing, supervision), emotional, medical, educational
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| what is physical abuse? | Physical injury. consider abuse regardless of intent to harm
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| Sexual abuse? | fondling, penetration, incest, rape, exploitation
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| 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
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| who are mandated reporters? | Varies by state, HCP are always mandated reporters regardless of state
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| 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.
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| Where would you most likely find intential injuries | Trunk, buttocks/low back, eyes, ear lobes, scalp, genitals, upper arms, ankles/feet/wrists
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| Where would you most likely find accidental injuries | shins, elbows, knees
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| Bruises | dating of bruises is controversial. document: mongolian spots, bruises, different colors
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| 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
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| Bites | adult bite marks are diagnostic if the psace between the canine teeth marks is >3cm
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| 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),
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| Head injury | shaken baby syndrome, skull fractures, most common cause of child abuse related deaths
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| Internal injry | injury might not be visible, internal injury 2nd leading cause of death in child abuse cases
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| 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,
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| DDX | Bruises: accidental injuries, mongolian spots, allergic shiners, bleeding disorders, cultural practices. Burns: impetigo, scalded skin syndrome, FX: osteogenesis imperfecta, neoplasms
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| diagnostic studies | Coagulation studies, serum Ca, phosphorus, Xray, bone scan, MRI ulstrasound. Depends on the kind of abuse you suspect
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| 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
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| signs of STD's | confirmation of gonorrhea or shyphils is always abuse. All other stds can be transmitted nonsexulally (still should be reported)
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| Signs of emotional abuse | change in self-confidence, HA, stomach ache, nightmares, attempts to run away
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| Management of child abuse case | thorough H&P, consider differentials, report suspicions, carefully docuemtn findings, refer as indicated
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| 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
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| How do you prevent child abuse | identify children at risk, screening, patient education
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