Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
27 Cards in this Set
- Front
- Back
|
Child Maltreatment syndromes include
|
Neglect >50%
Physical Abuse 10-20% Sexual Abuse 10-20% Emotional Abuse ? |
|
|
Greatest modality of child abuse
|
Neglect
|
|
|
Factors Associated With Increased Risk of Abuse
|
Young maternal age
Single parent households Ethnic minority status Parental alcohol/drug abuse |
|
|
Any act against a
child that results in harm or intended harm to the child |
Physical Abuse
|
|
|
Can bruises be effectively dated?
|
no
|
|
|
peak ages of child poisoning
|
toddler age
|
|
|
What is the physical pattern of a non-accidental burn?
|
bilateral and symmetric
|
|
|
Burn patterns that may suggest physical maltreatment include the following:
|
Patterned burns
Classic forced immersion burn pattern with sharp stocking and glove demarcation and sparing of flexed protected areas Splash/spill burn patterns not consistent with history or developmental level Cigarette burns |
|
|
Other concerning aspects to the burn physical examination that should raise the concern for possible abuse include the following:
|
Incompatible history and physical examination
Incompatible burn and developmental level Bilateral or mirror image burns Localized burns to genitals, buttocks, and perineum (especially at toilet training stage) Evidence for excessive delay in seeking treatment, and the presence of other forms of injury |
|
|
Bruising over bony prominences are common in childhood, but patterns of bruising that raise the concern of possible abuse include the following:
|
Involvement of multiple areas of the body beyond bony prominences
Bruises at many stages of healing Bruises in non-ambulatory child Markings resembling objects, grab marks, slap marks, human bites, and loop marks |
|
|
What are the most common type of fracture seen in abuse
|
Skull fractures
|
|
|
Humerus and femur fractures (especially if age <1 yr) should raise suspicion
___ fractures are more specific for abuse |
Humerus and femur fractures (especially if age <1 yr) should raise suspicion
Rib fractures are more specific for abuse |
|
|
Four types of OI exist, as follows:
|
Type I is the most common form, has autosomal dominant inheritance, and is responsible for 80% of cases. Type I may easily be confused with maltreatment. Other major findings of type I include mildly to moderately severe bone fragility with occasional fractures at birth, easy bruising, short stature, and blue sclera. Type I OI may be associated with family history of hearing impairment.
Type II is a perinatal lethal form. Death typically occurs by age 1 month, with multiple fractures at birth. Type III is rare and is easily distinguished from maltreatment because of severe bone fragility and osteopenia, triangular facies, ligamentous laxity, skeletal deformity, and the appearance of teeth. Type IV is the most difficult to distinguish from maltreatment because bones may appear normal when the first fracture develops but are usually characterized by mild-to-moderate bone fragility, osteopenia, wormian bones, birth fractures in approximately one third of cases, and normal sclerae. Genetic consultation is necessary to pursue a more detailed workup for OI and the characterization of the collagen disorder. |
|
|
Fractures that raise a high degree of suspicion for inflicted injury include the following:
|
Metaphyseal fractures
Multiple, bilateral, differently aged posterior rib and scapular fractures Multiple and complex skull fractures Spinous process fractures Spiral fractures in nonwalking infants |
|
|
Metaphyseal fractures
Multiple, bilateral, differently aged posterior rib and scapular fractures Multiple and complex skull fractures Spinous process fractures Spiral fractures in nonwalking infants |
Metaphyseal fractures
Multiple, bilateral, differently aged posterior rib and scapular fractures Multiple and complex skull fractures Spinous process fractures Spiral fractures in nonwalking infants |
|
|
Physical indicators that should raise suspicion for maltreatment include the following:
|
Injury pattern inconsistent with the history provided
Multiple injuries/multiple types of injuries Injuries at various stages of healing Poor hygiene Presence of pathognomonic injuries including loop marks, forced immersion burn pattern, and classic shaken baby findings of SDH, retina hemorrhage, and skeletal injuries |
|
|
Mother (rarely the father) makes up symptoms of an illness for the child and/or causes illness then takes internal pleasure in the child undergoing multiple tests and procedures
Mother frequently a member of the health care profession |
Munchausen Syndrome by Proxy
|
|
|
Most common form of child maltreatment
|
Neglect
|
|
|
Only ~__% of sexually abused children will have physical findings
|
Only ~20% of sexually abused children will have physical findings
|
|
|
Sexually abused children exhibit variable behaviors including:
|
Poor School Performance
Anxiety Encopresis Suicidal Gestures Sexually overt behaviors |
|
|
Sexual perpetrators are almost always male
__% of perpetrators are <18 |
Sexual perpetrators are almost always male
20% of perpetrators are <18 |
|
|
Recent studies estimate that __-__% of adult women and _-__% of adult men were sexually abused as children
|
Recent studies estimate that 15-20% of adult women and 5-10% of adult men were sexually abused as children
|
|
|
Position ideal for optimal visualization of the genital structures with a fair degree of comfort for the child
|
Frog-leg position
|
|
|
Provides clear observation of the anus
Offers an opportunity to examine the vulvar structures, including the hymen, from a different vantage point |
Knee-chest position
|
|
|
Emotional maltreatment is probably on of the most common forms of abuse but it is difficult to define or identify
Includes ----- |
Repeated verbal denigration
Belittling Making-fun-of Scapegoating for problems that have nothing to do with the child May lead to low self-esteem and feelings of worthlessness |
|
|
To find abuse you must have a mindset that abuse is possible
If there are discrepancies, trust the a) injury b) history |
a) injury
|
|
|
Histories that should raise your suspicion
|
Serious injury with no history of preceding trauma
History inconsistent with physical findings Delay in seeking medical advice History keeps changing History of recurrent injuries |
