Child Abuse
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| Define NAI. | Non Accidental Injury.
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| What ages were the most susceptible to child abuse in 2009 to 2010? | 50% 5-10 years.
35% under 5 years.
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| What are the top forms of abuse reported? | 1. Emotional abuse.
2. Relationship/behavioral.
3. Neglect.
4. Physical.
5. Sexual.
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| What are the three most common factors associated with child homicide? | Drug or/and alcohol abuse.
Physical punishment.
Extreme response to partner separation.
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| What are the four categories of child abuse? | Physical abuse.
Physical neglect.
Sexual abuse.
Emotional abuse.
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| What are possible questions you may ask during a possible child abuse focused history? | How and when did the injury occur?
Is there and adequate explanation?
Is there consistency in the stories?
Does the injury pattern match the mechanism of injury?
Does the child's development match the injury?
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| What may be a dead giveaway of an intentional burn? | No splash marks - clear demarcation lines.
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| What type of fracture is especially suspicious in small children. | Rib fractures - especially posterior, lateral and multiple fractures.
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| Why are <2yr old children especially susceptible to shaken baby syndrome? | Weak neck muscles.
Proportionally larger head.
Brain is poorly myelinated and has a larger subarachnoid space.
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| What are red lights for Physical abuse? | Unexplained bruises, burns or welts with linear patterns.
Bites or fingernail marks.
Anti-social behaviour.
Problems at school.
Fear of adults/caregiver.
Does not cry during painful procedures.
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| What are red lights for sexual abuse? | Inappropriate interest or knowledge of sexual acts.
Nightmares and bed wetting.
Drastic changes in appetite.
Over-compliance or excessive aggression.
Fear of particular family member.
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| What are red lights for neglect? | Unsuitable clothing/footwear for weather.
Dirty or un-bathed.
Extreme hunger.
Apparent lack of supervision.
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| What are red lights for emotional abuse? | Apathy.
Depression.
Hostility or stress.
Lack of concentration.
Eating disorders.
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| What are the management for potential NAI? | Manage ABCs.
Be alert for any abnormal signs or signals.
Perform detailed assessment.
Obtain detailed Hx of cargiver and child. Find a way to talk to the child alone.
Note behaviour and interaction of child and caregiver.
DOCUMENT everything.
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