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Children and Adolescents at Risk

Terms

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Child abuse
physical injury, sexual abuse, deprivation of nutrition in circumstances where this is non-accidental. 20:1000 children
History suggestive of abuse
inappropriate parental concern frequent accidents previous injury/abuse in siblings inconsistant histories social situation crisis
Features on physical exam suggestive of child abuse
- injury inconsistant with childs developmental level Bruising/injury at unusual site eg. flexor surfaces, back, soles, buttocks - burns and scalds - non-organic FTT, developmental delay, emotional behavioural disturbance - fear or apathy in child - subdural haematoma or retinal haemorrhage (shaken child) - facial brusing
Fractures suggestive of child abuse
- metaphyseal - posterior rib - spinous processes - sternum - hands and feet - complex skull fractures - vertebral body - muliple fractures - fractures of different ages
Investigations when suspecting child abuse
Skeletal survey = skull XR and bone scan Coagulation studies Glutaric aciduria CT and MRI if CNS Ensure child does not have osteogenesis imperfecta or coagulopathy
Indicators of child abuse
direct report from child adolescent pregnancy pre-pubescent venereal disease genital/rectal trauma precocious sexual interest hx of sexual abuse in the family socially withdrawn child fear/distrust of authorities self esteem down/depression/suicidal/substance abuse somatic complaints (abdo, pelvic pain)
Mechanisms of NAI- Head trauma
violent shaking with or without impact shaking with impact usually associated with a skull fracture accel/decel forces with rotation - shearing forces tear dural bridging veins retinal haemorrhages are more common in shaking injuries short falls do not explain injuries seen infants under 3 months cannot usually roll off a bed/chair
Who is most at risk of NAI - head trauma
- infants less than 6 months - first child - colic common - FTT noted in a large number - premature - child perceived as having a difficult temperement
Who is most likely to give a child an inflicted head injury
- often has hx of abuse - often father or male figure in household - young parents who have poor social supports, financial and housing problems - siblings are at risk of inury - assess for domestic violence and substance abuse
potential outcomes for inflicted head injury (shaken baby)
- blindness - cerebral palsy - learning and speech disabilities - seizure disorders - behavioural disorders - hydrocephalus - death 1/3 die 1/3 permanently disabled
Hx to ask when assessing for child abuse
-medical hx - factors in carers - factors in child - factors in environment
Burn signs of abuse
does the burn pattern match the story immersion burns - clear demarcation with no splash marks delay in treatment a bad sign cigarette burns always a bad sign -immersion burns with sparing on buttocks or anterior abdomen where skin folds - imprint of a hot object such as iron or radiator bar

Deck Info

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