Child Abuse

1. Child Abuse When To Suspect, What To Do

2. When To Suspect?

3. When To Suspect • Suspect abuse with any unusual physical or psychological complaint • Is the injury consistent with the history?

4. You Need To Know • Identify signs and symptoms of suspected abuse • Maintain a safe environment for the child • Maintain objectivity • Understand legal requirements for reporting suspected child abuse

5. You Need To Do • Case management should be a team approach • Physicians and nurses • Social services • Law enforcement agencies • Consultation with needed specialties • Photograph signs • Draw on traumagram • Document, document, document

6. INCIDENCE OF ABUSE?

7. INCIDENCE OF ABUSE Incidence: 22-30/1000

8. Non accidental trauma can involve many different organ systems • Soft tissue/skin • Head and neck injury • Chest injury • Abdominal injury • Skeletal trauma • Genitalia

10. Bruises?

11. Bruises • Common to all children • Accidental injuries typically occur on the forehead and extremities • Bruising can occur secondary to medical conditions • Leukemias • Idiopathic thrombocytopenia purpura (ITP) • Coagulopathies (bleeding disorders)

12. Bruises • Suspicious injuries

13. Bruises • Suspicious injuries • Occur in different planes of the body • Different stages of healing • Central distribution • Injuries to the back • Pattern injuries

14. Bruises • Bruising and other soft tissue injury is extremely uncommon in children younger than 6 months of age • Any bruising on an infant <6 months of age should be considered suspicious for abuse • Contusions are the most common injury sustained to the head and face

20. Handmarks • Bruising occurs in the tissues between the fingers, where tissue is squeezed or compressed • Slap marks • Grab marks • Knuckle marks

21. Bruises from grabbing the upper arm

22. Slap marks across the face

23. Pattern marks • Injuries that occur from foreign objects will often leave specific patterns or markings • Ropes • Cords • Belts and belt buckles • Shoes • Kitchen tools

26. Discipline? Or Abuse?

27. Discipline?

28. Discipline AAP Guidelines for Effective Discipline (2002): Discipline is a multifaceted approach to assuring a child’s safety and successful development, involving positive as well as negative reinforcement.

29. Abuse?

30. Abuse • “Corporal punishment” is child abuse if: • It’s performed when the adult is angry or out of • control • The intention is to inflict pain • Involves anywhere other than the clothed buttocks or • backs of the thighs • Leaves a mark for more than a few minutes • An object is used (belt, cord, paddle…)

32. Burns?

33. Burns Thermal injuries can be caused by accident, abuse, or neglect

34. Burns • Pattern of injury is important • Burns secondary to falling or splashing of hot liquid should have a non specific pattern • Inflicted injuries typically involve many different planes • Thermal injuries with a stocking glove distribution represent immersion injuries • Is the injury consistent with the history?

35. Intentional burn injuries • Extent of the burn depends on: • Water temperature • 47° C is the threshold for scald injuries • Duration of exposure • 3rd degree burns occur on adult skin after: • 1 minute in 52° C water • 30 seconds in 54° C water • 2 seconds in 65° C water

41. Skin Protected by skin folds Skin protected by bottom of tub

42. Protected Areas

43. Contact burns • Typically leave a patterned mark • Cigarette lighters • Irons • Heaters

44. Contact Burn Patterns

47. Iron; floor

48. Iron; butt

49. "Sat on curling iron" (AAP)

50. AAP