Define Child Abuse
Serious injury inflicted upon a child by a parent or caretaker
Major Types of Child Abuse
Physical abuse
Sexual abuse
Emotional abuse
Child neglect
Most common perpetrators in child abuse
Biological parents
Nonbiological parents/partners
Other adult
Risk Factors for Child Abuse
Young or single parents
Lower levels of education
Abusers were abused themselves as children
Drugs/alcohol addiction and/or psychiatric illness
Environment of Child Abusers
Stress factors within the family
Social isolation
Distant or absent extended family
Accepting violence as a means of problem solving
Children More Likely to be Victims
Younger than 3
Past abuse
Children with speech/language disorders, learning disabilities, non-conduct psych problems
Children with handicaps, chronic illness
Hyperactive, adopted, & step-children
Most prevalent form of child abuse
Child neglect
Define Child Neglect
Failure to provide for a child’s basic physical, emotional, education, or medical needs
Types of Child Neglect
Physical neglect
Emotional neglect
Educational neglect
Medical neglect
Management of Child Neglect
Identify/recognize the problem
Discuss with family/interdisciplinary team
Management of Cases of Medical Neglect
Simplify care as much as possible
Give written instructions
Remove barriers to access
Why hospitalize a patient for child neglect?
Serious medical conditions
Protect the child
Observe parent/child interaction
Clinical Manifestations of Child Neglect
Orofacial injuries Bruises Bite marks Burns Fractures
Types of Orofacial Injuries in Child Neglect
Intraoral injuries Burns Maxilla, mandible, or facial bone fractures Oropharyngeal gonorrhea or syphilis Black eyes Basilar skull fracture Bruising/scarring corners of the mouth Traumatic alopecia
Bruises in Abused Children
In clusters
In pattern of an implement suggest inflected injury
Ligature marks or rope burns
Differential Diagnosis of Bruises
Bleeding disorders
Salicylate ingestion
Henoch-Schonlein purpura
Mongolian spots
Types of Burns
Brands/contact burns Cigarette burns Immersion burns Microwave oven burns Stun gun burns
Reason to Suspect Fractures
Doesn’t fit explanation
Multiple stages of healing
Differential Diagnosis of Burns
Phyophotodermatitis
Complementary & alternative therapies
Congenital insensitivity to pain
What are some complementary and alternative therapies?
Garlic applied to skin
Cupping
Coining
Moxibustion
What to assess in the PE
Skin lesions, swelling, deformity
Bone tenderness
Retinal hemorrhages
Trauma to genitals or mouth
Parental behaviors that may lead to child abuse
Arguing, roughness, or violence
Aloofness/lack of emotional intersection
Inappropriate response to severity of injury
Inappropriate delay in seeking medical care
Partial/frank confession by parent
Lab/Studies to Diagnose Child Abuse
CBC, PT, PTT CMP UA- hematuria Toxicology Skeletal survey Neuro-imaging Ophthalmologic exam
Define Sexual Assault
Attempted sexual touching of another person without their consent & includes sexual intercourse, sodomy, and fondling
Define Sexual Abuse For Children
When a child engages in sexual activity for which he/she cannot give consent, is unprepared for developmentally, cannot comprehend, and/or an activity that violates the law or social taboos of society
Sexual Abuse Includes
Fondling Oral-genital, genital, or anal contact with a child Exhibitionism Voyeurism Involving child in porn
Define Exhibitionism
Man/woman shows naked body to another
Define Voyeurism
Peepers looking at naked children
Presentation of Sexual Abuse
Stomach ache Sore throat Rectal/genital bleeding STIs Pregnancy Rectal/genital trauma
Goals of Evaluation of Sexual Abuse in Child
Identify injuries Screen/diagnose STIs Evaluate/reduce risk of pregnancy Document findings Gather evidence
Children who witness intimate partner show an increase in what?
Aggression/conduct disorders Impulsivity Anxiety/intrusive thoughts Disrupted sleep patterns and depression PTSD May lead to risky behavior
Screening for Child Abuse/Neglect
RADAR
What does RADAR stand for?
R- routinely screen patients for abuse
A- ask direct questions
D- document your findings
A- assess safety of victim & children
R- review options/referrals/ reporting requirements
Barriers to Reporting Child Abuse/Neglect
Alternative strategies could be more effective than CPS
Inadequate training
Cultural attitudes
Perception that CPS ineffective
Types of Child Neglect
Physical neglect
Emotional neglect
Educational neglect
Medical neglect
Approach to Neglect
Discuss with caregivers the concerns
Team approach
Reportable
Emotional Abuse
Rejecting Isolating Terrorizing Ignoring Corrupting Verbal assault or spurning Over pressuring
Emotional Disturbance Clinical Features of Emotionally Abused Children
Anxiety
Depression
Agitation
Fearfulness
Social Withdrawal Clinical Features of Emotionally Abused Child
Running away from home
Developmental delay
Drug or alcohol problems
Eating disorders