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Child Abuse. What we can do as medical providers Ashlee Walls MD Commuity Medicine Didactics February 14th 2012. Take home points. Child abuse is common, it will be in your practice! Think about child abuse, especially when the story doesn’t fit. There are protocols for exams.

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child abuse

Child Abuse

What we can do as medical providers

Ashlee Walls MD

Commuity Medicine Didactics

February 14th 2012

take home points
Take home points
  • Child abuse is common, it will be in your practice!
  • Think about child abuse, especially when the story doesn’t fit.
  • There are protocols for exams.
  • Consequences are vast and include death.
  • There are strategies of prevention that you can include in practice – but overall prevention is a societal issue.
definition
Definition
  • The Child Abuse Prevention and Treatment Act (CAPTA) defines abuse as a recent act or failure to act that results in death, serious physical or emotional harm, sexual abuse or exploitation, or imminent risk of serious harm; involves a child; and is carried out by a parent or caregiver who is responsible for the child’s welfare
epidemiology
Epidemiology

*9.2/1000 children per year are unique victims of maltreatment

10/1000 children per year are duplicate victims of maltreatment

case 1
Case #1
  • 3mo girl presents to ED with recurrent vomiting admitted to FMS for observation, discharged home stable.
  • 5 days later presents with “unresponsive episode”. Bulging fontanelle. To PICU.
evaluation
Evaluation
  • AAFP Statement
  • Swedish Protocol
    • Serial Occipital Facial circumference
    • Full skin exam including genitals and oropharynx
    • Early consultation – ortho, surgery, CPS
    • Skeletal Survey (repeat at 10-14 days)
    • Opthalmology for retinal hemorrhages
    • Head CT (+/- MRI)
    • Consider r/o OI, bleeding d/o, glutaric aciduria 1
case 2
Case #2
  • 2 ½ yo girl calls clinic with “vagina hurts and foul smelling discharge.
  • Seen 3 weeks ago for urinary frequency.
  • Does not show to appointment.
concerning signs symptoms1
Concerning signs/symptoms
  • Sexualized behavior
  • Emotional disturbances
  • Developmental delay
  • Genital complaints
evaluation1
-Child advocacy centers part of National children’s Alliance do these exams – http://www.nca-online.org

-Evaluation at Harborview Center for Sexual Assault and Trauma to insure precise and acceptable collection of evidence. Contact 206-744-1600.

Evaluation
case 3
Case #3

1 yo female by EMS to Marybridge ED. Found in bathtub, CPR started at scene. PALS for 15 min in ED then called.

On exam, no wet hair, bruising on abdomen, gapping anus.

Had seen PCP few times in last month for abdominal pain.

consequences2
Consequences
  • Delay in developmental milestones
  • Refusal to attend school
  • Separation anxiety disorders
  • Future substance abuse
  • Aggressive behaviors
  • High risk health behaviors
  • Criminal activity
  • Depressive and Affective disorders
  • Personality Disorders, Somatization
  • PTSD, Panic Attacks
  • Schizophrenia
  • Abuse of their own children and spouse (30%)
  • More diabetes, cancer, CAD
  • Cost
how to help
Report

Believe children

Screening?

Prevention

How to help
prevention
Prevention
  • Social strategies proposed but unproven:
    • Increasing value of children in society
    • Increasing economic self-sufficiency of families
    • Enhancing communities and their resources
    • Discouraging excessive use of corporal punishment and other forms of violence
    • Making healthcare more accessible and affordable
    • Improving coordination of social service
    • Improving treatment for alcohol and drug abuse
    • Improving identification and treatment of mental health problems
    • Increase availability of affordable childcare
    • Prevention of unwanted births
  • Only Long-term home visitation (up to 2 yrs) has been found to be effective in reducing the incidence of child abuse.
what can you do
What can you do
  • Diagnose pregnancy and explore impact with mothers
  • Assess stressors in new parents
  • Identify substance abuse, mental health and DV
  • Offer new parents: social worker, long-term home visitation, parenting classes
  • Educate parents on: nutrition, safety, discipline, development (physicians spend 1 min)
  • Discourage corporal punishment
  • Provide after hours care
  • Care for patients of low SES
  • Support community strategies
take home points1
Take home points
  • Child abuse is common, it will be in your practice!
  • Think about child abuse, especially when the story doesn’t fit.
  • There are protocols for exams.
  • Consequences are vast and include death.
  • There are strategies of prevention that you can include in practice – but overall prevention is a societal issue.
local resources
Local Resources
  • Child health, development (including free developmental screen), immunizations. Find a doctor or get free or low-cost health insurance for your child. Breastfeeding, food, WIC. : Family Health Information and Referral Line 1-800-322-2588 or visit http://ParentHelp123.org. Part of DSHS.
  • Help if you feel upset with your baby. Parenting classes. Child sexual abuse, physical abuse, information and support. Developmental screening. Parenting coaches:
  • Family Help Line, 1-800-932-4673(HOPE) or http://www.parenttrust.org
  • Child abuse hotline: 1-800-4-a-child or visit http://www.childhelpusa.org/
  • Parenting information and support groups: Program for Early Parent Support (PEPS) http://www.pepsgroup.org/
more resources
More Resources
  • Crisis counseling Childhelp USA (http://childhelpusa.org). Telephone: 1-800-4-A-Child (1-800-422-4453)
  • State statutes Child Welfare Information Gateway (http://www.childwelfare.gov/systemwide/laws_policies/search/index.cfm)
  • National Committee to Prevent Child Abuse http://www.childabuse.org
  • National Council on Child Abuse and Family Violence 1-800-222-2000
my resources
My Resources
  • National Child Abuse Statistics http://www.childhelp.org
  • NSPCC Inform. The online child protection resource. www.nspcc.uk/inform
  • Tips For Conducting a Child Sexual Abuse Exam. ACEP News. June 2010. http://www.acep.org/content.aspx?id=48690
  • Bethea, L. Primary Prevention of Child Abuse. American Family Physician. 1999;59(6):1577-1585.
  • Horsley, L. AAP Guidelines on Evaluating Suspected Child Physical Abuse. American Family Physician. 2008;77(10):1461-1464.
  • Kellogg, N. The Evaluation of Sexual Abuse in Children. Pediatrics. 2005;116:506.
  • Lahoti, S; McClain, N; Girardet, R; McNeese, M; Cheung, K. Evaluating the Child for Sexual Abuse. American Family Physician. 2001;63(5):883-891.
  • McDonald, K. Child Abuse: Approach and Management. American Family Physician. 2007;75(2):221-228.
  • Swedish Protocol. Clinical Procedure: Medical Management for Child Abuse and Neglect. 2011.
  • Child Maltreatment 2010.