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Child Abuse


Child Abuse & Neglect for Health Care Providers – PowerPoint PPT presentation

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Title: Child Abuse

Child Abuse Neglect for Health Care Providers
  • Child abuse and neglect are widespread, found
    across all levels of socioeconomic status, all
    racial and ethnic (cultural) groups, and all
    religious affiliations.
  • Healthcare providers are in a unique position to
    identify abuse and neglect.
  • Moral and legal obligation to report abuse and
    neglect, whether suspected or confirmed.

Abuse Defined
  • Abuse A patient has suffered physical or
    emotional injury inflicted by a caregiver (eg,
    parent, legal guardian, teacher, etc) that
    results in disability, disfigurement, mental
    distress, or risk of death.

Neglect Defined
  • Neglect A childs physical, mental, or emotional
    condition has been endangered because the
    caregiver has not provided for the childs basic

The HCWs role
  • Recognize signs/symptoms of abuse and neglect.
  • Provide medical evaluation and treatment.
  • Protect from further abuse.
  • Report all cases of suspected abuse.
  • Document all findings accurately, thoroughly, and

Recognizing Abuse/Neglect
  • Importance of History
  • Injury or illness inconsistent with history
  • Critical to determine whether injury or illness
    could have been caused unintentionally or was
  • Multiple visits to ED from same household or
    previous visits for family violence

Recognizing Right to Privacy
  • Children have right to refuse
  • Adolescents especially sensitive
  • Do not examine unwilling child, especially if
    sexual abuse is suspected
  • Give choices if possible

Recognizing Skin Injuries
  • Most common and easily recognized sign of abuse
  • Conduct complete, thorough skin examination
  • Always look for cuts, scrapes, bruises, burns,
    bites, redness, swelling
  • Describe systematically and consistently when

Recognizing Bruises
  • Note location(s)
  • Infants rarely bruise accidentally
  • Young, active children tend to incur bruises
    naturally on front of body (eg, knees, shins,
    elbows, forehead)
  • Bruises in recognizable shape of object are
  • Multiple bruises in different stages of healing
    are suspect

Recognizing Burns
  • Scald burns common
  • Two general patterns immersion and splash
  • Immersion burns characterized by clear lines of
  • Examples Donut pattern burn on buttocks or
    stocking/glove pattern burns of arms or lower
  • Accidental burns more often have splash marks as
    child withdraws from heat source

Recognizing Bites
  • Adult human bite marks strongly suggest abuse
  • In general, bite marks are multiple, random, well
  • No one tooth mark stands out (differing from
    animal bites)

Recognizing Fractures
  • Fractures discovered accidentally
  • Skeletal injury inconsistent with history
  • Multiple fractures in different stages of healing
  • Accompanied by other injuries

Recognizing Falls
  • Fall from standing position or low object (less
    than childs height) rarely results in serious
  • Fall from greater than childs height usually
    required to sustain serious injury

Recognizing Injuries to Face Head
  • Unintentional injuries usually involve front of
  • Specific injuries to side of face, cheeks, ears
    suspicious of abuse
  • Direct blow to mouth usually results in lip tear,
    possibly with broken jaw or teeth
  • Considerable force required to cause severe head

Recognizing Hair Loss
  • Can be manifestation of child abuse
  • May be self-inflicted to relieve stress
  • Can be caused by dragging child by hair, using
    excessive force during brushing, or certain types
    of hair braiding
  • Often blood at the surface or beneath scalp

Recognizing Shaken Baby Syndrome
  • Most common in children less than 2 years old
  • May be no evidence of external trauma
  • Possible signs include decreased consciousness,
    seizures, vomiting, other signs of head injury,
    unusual cry
  • Altered mental status may be only sign
  • Recognizing the possibility should trigger
    suspicion of abuse

Recognizing Sexual Abuse
  • Signs may include pain, bleeding, or discharge
    from urethra, vagina, or rectum
  • Can also be insidious, chronic, hidden abuse
    occurring over weeks or months
  • In these cases, signs may include nonspecific
    abdominal pain, vaginal inflammation, or painful
  • Physical examination normal in most cases

Treating sexually abused patients
  • Believe what the child says
  • Use the childs own words and document statements
    in quotes
  • Never examine unwilling child
  • Do not remove childs clothing or examine
    genitals unless severe genital pain or gross
    genital bleeding
  • Refer child to specialist for examination

Recognizing Emotional Abuse
  • A component of all forms of child abuse
  • Attack on childs development of self and social
  • May not be done on conscious level
  • Most cases mild, but early recognition important

Recognizing Emotional Abuse
  • Ignoring the child
  • Rejecting the childs needs and requests
  • Isolating the child
  • Verbally assaulting the child (eg, name-calling,
    harsh threats)
  • Encouraging destructive, antisocial behavior
  • Humiliating the child

Recognizing Neglect
  • Most common form of child abuse
  • Likely most under-recognized and under-reported
    form of child abuse
  • Neglected children suffer greatly, often left
    with emotional scars

Recognizing Neglect
  • Inadequate care, including inadequate provision
    of food, clothing, or shelter
  • Inadequate medical attention, including delay in
    seeking care for known illness
  • Example While child is having asthma attack,
    mother leaves home to go shopping.

Recognizing Neglect
  • Signals to watch for
  • Poor personal hygiene
  • Unsanitary conditions
  • Inadequate sleeping arrangements
  • Lack of supervision
  • Evidence of substance abuse
  • Structural, fire, environmental hazards

Recognizing Munchausen Syndrome by Proxy
  • Bizarre and rare form of child abuse
  • Illness in child is repeatedly induced by parent
    or other caregiver, who denies knowledge of cause
  • Symptoms subside when child is separated from
    parent or caregiver
  • Child should not be left alone with parent or

Cultural Considerations
  • Childrearing practices greatly influenced by
  • Examples babies allowed to cry themselves to
    sleep, children sleeping in parents bed for
    several years
  • Practice considered abuse in one culture may be
    norm in another
  • Examples scarification of face, physical

Cultural Considerations
  • Cultural differences may affect evaluation of
  • Important to be aware of other cultures in own
  • Families may not realize that certain practices
    are considered abuse in US

Folk Medicine Practices
  • May mimic abuse
  • Should not be reported as abuse (usually)
  • Examples
  • Coin rubbing rubbing a coin along the skin may
    produce bruise-like rash
  • Cupping applying heated cup to skin and pulling
    off after suction develops causes circular
  • Moxibustion treatment related to acupuncture in
    which lighted objects placed on skin result in

Communicating with Caregivers
  • The primary goal is to protect the child from
    further injury.
  • Families likely to react negatively
  • Best to discuss in a place where assistance is
    immediately available
  • Police presence may be desirable

Reporting Abuse/Neglect
  • Reports must be made when child abuse or neglect
    is suspected or there is reasonable cause to
    believe that child abuse or neglect has occurred
  • Proof is NOT required

Reporting Abuse/Neglect
  • Reasonable Cause When the pre-hospital provider
    HCW becomes aware of the possibility of neglect
    or abuse they have a duty to report

Reporting Abuse/Neglect
  • The reasons for reporting are
  • to determine whether or not an investigation will
  • to determine whether or not abuse or neglect
  • to determine what happened and who is responsible
  • to safeguard the child from future injury

Legal Obligations
  • Immediate notification to DCF required for
    parents of an infant who have requested
  • deprivation of nutrition necessary to sustain
  • deprivation of medical or surgical interventions
    necessary to remedy or ameliorate a
    life-threatening condition (may not apply to
    terminally ill children if treatment would be

Legal Obligations
  • Laws protect a person making a report in good
    faith, by making them immune from civil or
    criminal liability
  • Failure to report or actions to prevent someone
    else from reporting is a misdemeanor with a fine
    of up to 500 or imprisonment of up to 1 year.
    Such individuals are also civilly liable for
    damages caused by their failure to report.