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child abuse & neglect: essential information for practicing

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child abuse & neglect: essential information for practicing & presiding in child welfare cases karen t. campbell, md forensic pediatrician medical director, cyfd/ps – PowerPoint PPT presentation

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Title: child abuse & neglect: essential information for practicing


1
CHILD ABUSE NEGLECTESSENTIAL INFORMATION FOR
PRACTICING PRESIDING IN CHILD WELFARE CASES
  • KAREN T. CAMPBELL, MD
  • FORENSIC PEDIATRICIAN
  • MEDICAL DIRECTOR, CYFD/PS
  • CO-MEDICAL DIRECTOR UNM CART

2
Incidence and Prevalence
  • There were approximately a million victims of
    Child Maltreatment in 2005 in the United States.
  • The rate of victimization in the United States is
    12.1 children per 1000 children.

3
Further breakdown of statistics
  • In the United States-
  • 54 of the children suffered from neglect
  • 23 were physically abused
  • 12 were sexually abused.
  • Highest victimization rates were in the 0-3 year
    age group.

4
In New Mexico
  • The child population in New Mexico was 489,482
    in 2005
  • 32,950 children were the subject of a report for
    abuse/neglect in 2005
  • During the same year the rate of substantiation
    was 14.9 per 1000 children
  • 12 children died as a result of abuse/neglect
    during 2005

5
Remember, every day in America, four (4) children
die as a result of abuse and neglect!
6
  • INJURIES IN CHILD ABUSE

7
Examples of External Injuries
  • Contusions
  • Abrasions
  • Lacerations
  • Incisions
  • Thermal/Chemical/Scald Burns

8
Examples of Internal Injuries
  • Fractures
  • Contusion
  • Laceration
  • Incision
  • Ischemia
  • Edema
  • Hemorrhage

9
Common sites of Accidental Injuries
  • Forehead
  • Forearms
  • Elbows
  • Spinal Prominences
  • Hips / Iliac Crest
  • Knees
  • Shins

10
Common sites of Non-Accidental Injuries
  • Face
  • Ears
  • Neck
  • Upper Arms
  • Back
  • Chest and Abdomen
  • Upper legs
  • Buttocks
  • Genitalia

11
Differentiating between Accidental and
Non-Accidental Trauma
  • Age and/or developmental capability of the child
  • Parent/Caretaker explanation for how the injury
    occurred
  • Type of Injury
  • Location of Injury
  • Risk Factors-
  • Infant/Child and Parent/Caretaker

12
Child Abuse Work-up
  • History
  • Complete Physical Exam
  • Skeletal Survey
  • Head CT Scan
  • Bone Scan
  • MRI/MRA of the Head and Neck
  • Ophthalmology Exam
  • Chest/Abdominal CT Scan
  • Laboratory Studies
  • Genetics/Dysmorphology Consult

13
  • ABUSIVE HEAD INJURY

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NORMAL RETINA
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  • Corner Metaphyseal Fracture

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  • FRACTURES

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  • PATTERNED INJURIES

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  • BURNS

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  • CONDITIONS MISTAKEN
  • FOR
  • CHILD ABUSE

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  • CHILD NEGLECT

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DEFINITION OF NEGLECT
  • Historically, neglect has been difficult to
    define
  • Definitions have varied across states,
    disciplines, agencies, and individuals
  • Broadly stated, neglect is a condition where a
    childs basic needs are not being met by their
    parent(s) or caretaker(s)

48
TYPES OF NEGLECT
  • Physical Neglect
  • Inadequate food and housing
  • Adult substance abuse
  • Domestic violence
  • Failure to Thrive (FTT)
  • Educational Neglect
  • Truancy and school absences
  • Non-approved home schooling
  • Emotional Neglect
  • Medical Neglect
  • Lack of appropriate Well Child Care and
    immunizations
  • Lack of appropriate medical care for acute and
    chronic medical conditions

49
FAILURE TO THRIVE (FTT)
  • Growth failure from malnutrition
  • Drop of 2 or more standard deviations on a
    standard growth chart
  • Weight at less than the 3rd percentile
  • Can be organic or non-organic
  • Can be a combination of organic and
    non-organic

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RISK FACTORS IN FAILURE TO THRIVE
  • Medical
  • Chronic medical conditions
  • Illnesses, inborn errors of metabolism, heart
    disorders, pulmonary disorders, kidney disorders,
    genetic disorders
  • Congenital anomalies
  • Poverty
  • Parent-child interactive disorders
  • Family dysfunction
  • Parental mental health disorders
  • Parental characteristics
  • Child characteristics

52
WORK-UP FORFAILURE TO THRIVE
  • Complete history
  • Birth history, maternal prenatal history, past
    medical history of the child, family history,
    feeding history, feeding behaviors
  • Medical work-up as indicated by complete history
  • If no organic etiology is indicated by history,
    placing the child in the hospital, or other
    environment, and following the childs weight on
    an age-appropriate diet

53
  • For further information or questions, please feel
    free to contact me at
  • (505) 841-7755 office
  • (505) 540-9577 pager
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