Child abuse and neglect Rakan - PowerPoint Presentation

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Child abuse and neglect

Rakan

Telfah

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objectives

Definition

Types

Epidemiology

Doctor’s role

Management

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Definition

Child abuse  

is when a parent or caregiver, whether through action or failing to act, causes injury, death, emotional harm or risk of serious harm to a child.

Any intentional harm or mistreatment to a child under 18 years old.

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Who defines child abuse

Because personal definitions of abuse vary according to

religious

and

cultural

beliefs,

individual experiences

, and

family upbringing

, various physicians have different thresholds for reporting suspected abuse.

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Why do we care

increase the risk of the individual’s developing behaviors in adolescence and adulthood that predict adult morbidity and early mortality.

destructive to the normal physical or emotional development of a child

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Types

Neglect

Physical abuse

Sexual abuse

Emotional abuse

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Neglect

most common

, nearly half of the reports.

Child neglect

: omissions that prevent a child’s basic needs from being met. Like adequate food, clothing, supervision, housing, health care, education, and nurturance.

Signs

: poor hygiene, bad clothing, untreated medical issues, low weight.

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Emotional abuse

When the parent or caregiver harms the child’s mental/social development or constantly cause emotional harm.

E.g

. Ignoring /rejecting /telling them they are not good enough /using harmful curse words to describe them /constant yelling .

Signs:

delays in development /bed wetting /speech disorders /extreme emotions /anxieties/ extreme behaviours.

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Epidemiology

yearly in USA, 3 million reports of suspected maltreatment.

Approximately 1 million of these reports are substantiated after investigation by Child Protective Services (CPS).

These reports represent only a small portion of the children who suffer from maltreatment

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Parental surveys indicate that several million adults admit to physical violence against their children each year.

Many more adults report abusive experiences as children

In Jordan

in 2009

82.8% sexual

15.4% physical

1.8% other types

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Doctor’s role

Suspect

Report

Treat

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Suspicion

Hx

PE

Tests

Red flags

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Risk factors

Parental substance abuse.

Maternal depression.

Domestic violence.

most

frequently

reported perpetrators : mothers

serious injuries

: fathers or maternal boyfriends

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Physical and behavioral indicators

Significant injuries, and a history of trauma is

denied

.

History that

doesn’t fit

with the trauma.

Inconsistent

history.

History of self-inflicted trauma does not correlate with the

child’s

developmental abilities

.

Unexpected/ unexplained

delay

in seeking medical care.

Multiple organ systems are injured, including

injuries of various ages.

The injuries are

pathognomonic

for child abuse.

Repeated

injuries over a period of time.

Patterned

injuries (slap/ iron/ belt/ teeth).

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Feeling worthless and deserve it ,sad, cries frequently ,depression.

cannot recall how injuries occurred, or offers an inconsistent explanation, poor memory and concentration

wary of adults or reluctant to go home

often absent from school/child care

extremely aggressive or withdrawn, abusive behaviour and language.

poor sleeping, fear of the dark, frequent nightmares,

drug/alcohol misuse , suicide attempts

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Abuse is suspected easily if the child is

battered

, has obvious external injuries, If the child is

capable of providing a history

of the abuse

parent is

unwilling to provide

the correct history

nonoffending parent who is

unaware

of the abuse.

The child may be

too young or ill

to provide a history of the assault.

An older child may be

too scared

to talk or may have a strong sense of

loyalty

to the perpetrator

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Bruises

suggestive of abuse :

Patterned.

unusual distribution, (torso, ears or neck).

bruises in non-ambulatory < 2% is normal.

Bruises of multiple ages.

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Burns

Mostly scald burns /cigarette burns.

often occur around toilet training

These burns have clear lines of demarcation, uniformity of burn depth, and characteristic pattern.

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Fractures

diaphyseal fractures are most common in abuse (nonspecific)

Fractures in young, non-ambulatory children

involve multiple bones.

Certain fractures have a

high specificity

for abuse, such as rib, metaphyseal, scapular, vertebral, or other unusual fractures.

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Suspicious

skeletal survey

looking for occult or healing fractures.

One third of young infants with multiple fractures, facial injuries, or rib fractures may have occult head trauma.

Brain imaging

may be indicated for these infants

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Head trauma

The

leading cause of mortality

and morbidity from physical abuse.

Most victims are young; infants predominate.

Shaking

and

blunt

impact trauma cause injuries.

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Victims present with

neurologic symptoms

ranging from lethargy and irritability to seizures, apnea, and coma.

subdural hemorrhage

, often associated with progressive cerebral edema

retinal hemorrhages

(seen in many, but not all, victims).

skeletal trauma, including rib and classic metaphyseal fractures.

evidence of previous injury.

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Internal organ trauma (blunt trauma to the abdomen)

The lack of external trauma, inaccurate history, can cause delay in diagnosis.

A careful evaluation often reveals additional injuries.

Abdominal trauma is the

second leading cause of mortality

from physical abuse.

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sexual abuse

the involvement in sexual activities that they can’t understand, are developmentally unprepared and can’t give consent to.

can be a single event, but more commonly it is

chronic

.

Mostly involves

manipulation and coercion

and does not involve physical violence.

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Perpetrators are more often

male

than female ,individuals who have access to children.

Approximately 80% of victims are

girls

, although the sexual

abuse of boys is underrecognized and underreported

.

Children generally come to attention after they have made a

disclosure

of their abuse

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Hypersexual behaviors

in children should rise the suspicion.

Sexual abuse occasionally is recognized by the discovery of an unexplained

vaginal, penile, or anal injury

or by the discovery of a

sexually transmitted infection.

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Physical exam should be complete and careful inspection of the genitals and anus.

Mostly normal genitals at the time of evaluation.

injuries are more seen if presented

within 72 hours

and in children who report genital bleeding,

but they are diagnosed in only 5% to 10% cases.

Many types of sexual abuse (fondling, vulvar coitus, oral genital contact) do not injure genital tissue

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For children who present within 72 hours, you should identify acute injury and the presence of blood or semen on the child.

Injuries to the oral mucosa, breasts, or thighs should be noticed.

Forensic evidence collection is needed in a few cases and has the greatest yield when collected in the first 24 hours

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Few findings are diagnostic.

Highly specific findings include :

acute, unexplained lacerations or ecchymoses of the hymen, posterior fourchette or anus

complete transection of the hymen,

unexplained anogenital scarring,

pregnancy in an adolescent with no other history of sexual activity.

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The type of assault, identity and known medical history of the perpetrator, and the epidemiology of sexually transmitted infections in the community is considered.

The diagnosis of most sexually transmitted infections in young children requires an investigation for sexual abuse

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Commonly needed Tests

Tests for hematologic disorders

Liver enzymes

Magnetic resonance imaging (head/neck)

Computed tomography (head, abdomen)

Complete neurological assessment

Skin biopsy for fibroblast culture and/or venous blood for DNA analysis (for suspected Osteogenesis imperfecta)

Bone-mineralization disorder tests (blood calcium, alkaline phosphatase, phosphorus, vitamin D, and parathyroid hormone)

Retinal examination by an ophthalmologist

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Report

physicians are mandated by law to identify and report all cases of suspected child abuse and neglect. It is the

responsibility of CPS to investigate

reports of suspected abuse.

50% of physical abuse results in facial and head injuries that can be recognized by the dentist.

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In Jordan

, family protective system is manifested through the

National Task Force for Family Protection

, operating under the umbrella of the

National Council for Family Affairs (NCFA),

which represents sixteen governmental and non-governmental organizations working in various sectors related to the well-being of families

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Management

medical

treatment

for injuries and infections

careful medical

documentation

of verbal statements and findings

ongoing

advocacy

for the safety and health of the child

Parents always should be informed

of the suspicion of abuse and the need to report to CPS

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Prevention

Few partially successful primary prevention programs.

Visiting home nursing programs that begin during pregnancy and early childhood

Physician training in screening for risk factors in parents

Education of child and parents