Telfah objectives Definition Types Epidemiology Doctors role Management 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 ID: 931219
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Slide1
Child abuse and neglect
Rakan
Telfah
Slide2objectives
Definition
Types
Epidemiology
Doctor’s role
Management
Slide3Definition
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.
Slide4Who 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.
Slide5Why 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
Slide6Types
Neglect
Physical abuse
Sexual abuse
Emotional abuse
Slide7Neglect
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.
Slide8Emotional 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.
Slide9Epidemiology
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
Slide10Parental 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
Slide11Doctor’s role
Suspect
Report
Treat
Slide12Suspicion
Hx
PE
Tests
Red flags
Slide13Risk factors
Parental substance abuse.
Maternal depression.
Domestic violence.
most
frequently
reported perpetrators : mothers
serious injuries
: fathers or maternal boyfriends
Slide14Physical 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).
Slide15Feeling 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
Slide16Abuse 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
Slide17Bruises
suggestive of abuse :
Patterned.
unusual distribution, (torso, ears or neck).
bruises in non-ambulatory < 2% is normal.
Bruises of multiple ages.
Slide18Slide19Burns
Mostly scald burns /cigarette burns.
often occur around toilet training
These burns have clear lines of demarcation, uniformity of burn depth, and characteristic pattern.
Slide20Slide21Fractures
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.
Slide22Slide23Suspicious
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
Slide24Head trauma
The
leading cause of mortality
and morbidity from physical abuse.
Most victims are young; infants predominate.
Shaking
and
blunt
impact trauma cause injuries.
Slide25Victims 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.
Slide26Slide27Internal 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.
Slide28sexual 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.
Slide29Perpetrators 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
Slide30Hypersexual 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.
Slide31Physical 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
Slide32For 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
Slide33Few 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.
Slide34The 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
Slide35Commonly 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
Slide36Report
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.
Slide37In 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
Slide38Slide39Management
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
Slide40Slide41Slide42Prevention
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