Pediatrics [CHILD ABUSE]

Introduction Abuse Neglect

Kids and the very elderly are at highest risk for abuse. They’re + Sxs - Sxs
completely dependent on care-givers and require a lot of attention and Intentional Absence
care. Abuse comes in two forms: abuse and neglect. Abuse is doing the Active Passive
things you shouldn’t, neglect is not doing the things you should. If
either are suspected in a child, it must be reported to child protective
services. We can also admit the patient for safety, even if medical
issues aren’t present to warrant the admission. Physical abuse is often
the subject of testing, but psychological abuse is something to be
cognizant of for real life.

Risk factors for abuse Risk Factors For Abuse

Risk factors come down to care-giver risk and child risk. Care-giver Child Parental
risk comes from increased stress or decreased support. Things like Intellectual Disability Those who were abused
single-parent, young parental age, and low socioeconomic status Premature Birth Single Parent
increase the chances of having coping mechanisms and put the parent Physical Disability Young Parent
at increase risk of abusing their child. Those who were abused will Cognitive Disability Low Socioeconomic Status
abuse more often (most significant risk factor). On the child side, Non-biological care-giver
things that increase stress to the parent are things that make parenting
more difficult: intellectual disability or other physical or cognitive
disability. These situations require extensive counseling and safety net How to spot abuse
policies (people, places, support) to ensure adequate care. Finding Things to look for
Fractures Skull or Clavicle
When to expect abuse Femur, especially spiral
In life, it’s often hard to spot. Any injury other than scrapes and bumps Rib fractures in infants
should at least have the consideration of abuse. The trouble is that kids Different stages of healing
explore, fall, play etc and accusing a parent of abuse is actually quite Bruises Different Stages of healing
caring can be destructive to the physician-parent relationship. However, Weird places for development
allowing abuse to continue is detrimental to the child's development, so Burns Feet, Ankles (Dunk)
a high index of suspicion must always be present. Buttocks only (Dunk)
Punctate circular burns (cigarettes)
On the test, look for obvious abuse. Femoral or Skull fractures are a Sexual Any STD in any child ever
board favorite; essentially no self-sustained injury can cause that, Vaginal or Anal trauma
especially in a child who isn’t a teenager. Subdural hematomas or
retinal hemorrhages are indicative of shaken baby. When different Behavior Not crying in the presence of care-giver
stages of healing (whether it be fracture or bruising) are seen, abuse Running from care-giver
has been diagnosed. Look for burns that would be hard to get Receiving comfort from health-care provider
independently ("dunk burns"). Finally, look for abnormal responses rather than care-giver
from the child; the absence of crying from severe trauma while in the
presence of a parent raises a lot of suspicion.
What to do if abuse is suspected
Sexual abuse has its own specific implications. If there’s ever any STD Element Considerations
in a child there’s been sexual abuse. Signs of vaginal or anal trauma are
Certainty Certainty is NOT required
difficult to explain in text (on a test), but those are also signs of abuse.
The Tell the family why you’re doing it and that
Usually NOT a stranger, it’s often a male parental figure but most
Family you’re required by law to do so
commonly brother-sister incest.
The Hospitalize child if no safe alternative exists
Child
What to do if abuse is expected
The Separate abuser from child if obvious
As a physician you’re obligated to report abuse to child protective
Abuser Separate parent-child unit from a common
services. The primary goal is safety. The secondary goal is to help the
abuser
family stay together and cope with stressors that are causing the abuse.
Behavior Offer resources and support that allows
Hospitalize the patient if no safe alternative exists. Call CPS. Get
families and care givers to understand disease
social workers involved. Get mom out of a dangerous household. Tell
process, provide emotional economic, and
the family that you must report and why you’re reporting - don't let the
physical support
police be the one to tell them. Separate the abuser from the child.

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