Child abuse

Question 1

T/F

We are mandated reporters

Answer 1

T

Question 2

What percent of children that die of abuse are under the age of 4?

Answer 2

70%

Question 3

What are the most common types of injuries in abuse cases?

Answer 3

craniofacial, head, face, neck

Question 4

What are some of the consequences of child abuse?

Answer 4

More likely teen pregnancy
More likely sexual risk taking
More likely substance problem
More likely psychological disorder
More likely criminal activity

Question 5

What are some of the risk factors for child abuse?

Answer 5

Family violence
Psychological factors in guardian
Substance abuse in guardian
Family stress
Child with special needs
Single parents

Question 6

What is the definition of abuse?

Answer 6

When a child’s parent, guardian or caretaker acts in the following ways:

• -Causes non-accidental injury
• -Uses a child for sexual purposes or involves a child in sexual acts
• -Harms a child’s mental or social development or causes severe emotional harm

Question 7

What are the key components for documentation of suspected abuse?

Answer 7

Who was caring for child
What events preceded the injury
Any witnesses
What was the child's reaction
What did the caregiver do
When did the injury occur
Where did it occur

Question 8

What are RED flags to be aware of in the history?

Answer 8

Injury incompatible with the child’s developmental abilities
Does the extent of injury make sense with the history
Absent, changing or evolving history
Delay in seeking medical care
Triggering event that precipitates loss of control in caregiver
Family crisis or stress
Prior history of abuse in caregiver

Question 9

Where will you find evidence of abuse?

Answer 9

Ears- pinch marks on both sides of ears
Triangle of safety- ears, side of face, neck and top of shoulders
Inner aspects of arms
Back and side of trunk except directly over spine
Black eyes (bilateral especially)
Soft tissue of cheeks
Intra-oral injuries
Forearms
Chest and abdomen
Any groin or genital injury
Inner aspects of thighs
Soles of feet

Question 10

What is the most common type of injury in an abused and in non-abused children?

Answer 10

bruising

Question 11

Bruising is highest in…

Precrusiers, cruisers or walkers?

Answer 11

walkers

Question 12

What are the non-intentional locations for bruises?

Answer 12

Forehead
Vertex of chin
Elbows
Knees/Shins

Question 13

What are the intentional locations for bruises?

Answer 13

Ears
Neck
Upper arms/legs
Abdominal wall
Buttocks/anus
Genitalia

Question 14

Time taken for appearance and resolution of bruise is dependent upon:

Answer 14

Attachment of tissue injured
Thickness of tissue injured
Type of injuring force
Depth of the injury
Vascularity of the injured/surrounding tissues
Underlying color of the injured person's skin
Age of patient
Underlying medical conditions

Question 15

What do colors of bruises mean?

Answer 15

Red/blue/purple- generally associated with recent bruising
Yellow/brown/green- generally associated with older healing bruising
Any of these colors can be observed in a bruise at any time before it fully resolves

Question 16

What is the importance of bruise dating?

Answer 16

Assessment of the age of a bruise in children is inaccurate and has no scientific basis

Question 17

What is patterned bruising?

Answer 17

the force of objects leaving a pattern on the soft tissue
Inflexible objects- may produce short linear bruises, bruising will reflect impact in one plane and should not follow curvature of affected region
Flexible objects- may cause a bruising pattern that follows the curvature of the body, commonly caused by extension cords, belts, ropes

Question 18

What coagulation disorders mimic bruising?

Answer 18

Leukemia
Vit K deficiency
Von Willebrand's
Thrombocytopenia
Hemophilia
Factor 8 deficiency

Question 19

What other disorders mimic bruising?

Answer 19

Dermal melanosis
Erythema multiforme
Purpura fulminans
Phytophotodermatitis
Allergic dermatitis
Insect bites
Self inflicted bruises
Abdominal striae

Question 20

What are the characteristics of bite injuries?

Answer 20

• -result from crushing pressure of the teeth as well as cutting from incisors and other teeth as the drag across skin
• -resulting cutaneous finding depends on force, duration, degree of movement between teeth and soft tissue bitten
• possible central ecchymosis related to either negative pressure of suction or tongue thrust, disruption of blood vessels enclosed within the area of the bite

Question 21

What are the characteristics of adult-inflicted bites?

Answer 21

often only distinct in one arch
avg maxillary intercuspid distance of 33mm
teeth tend to be rectangular

Question 22

What are the characteristics of child-inflicted bites?

Answer 22

bites are often distinct in both arches
intercuspid distance of less than 30 mm
teeth tend to be more rounded

Question 23

What are the characteristics of animal-inflicted bites?

Answer 23

generally tear skin

much narrower arch with elongated A-P aspect than human bites

Question 24

Where are the most common locations of human bites?

Answer 24

occur most frequently on upper extremities
may occur during play, fights, sport, sex
developmental biting behavior in preschool age often seen with frustration/anger
Adults may bite child to stop biting behavior

Question 25

What are the characteristics of liquid burns?

Answer 25

Scalding is most frequent form of abuse
More than 80% of abusive scald burns are from tap water
Observed patterns
--Immersion patterns
--Skin-sparing patterns of immersion

Question 26

What are the characteristics of contact burns?

Answer 26

Configured by the burning object

Abusive injuries often more sharply defined than accidental ones

Question 27

What do intentional cigarette burns look like?

Answer 27

Firm contact typically produces a sharply defined circular, 3rd degree burn
Approx. 5-10mm in diameter
Often on exposed areas- hands, feet, head and neck

Question 28

What are the characteristics of accidental cigarette burns?

Answer 28

Typically causes only superficial brush burns

Question 29

What are the characteristics of oral trauma?

Answer 29

Blunt impact
Insertion of object into mouth
Sexual abuse- petechiae, ulcerations, infection–oropharyngeal gonorrhea, condyloma
Burns with hot liquids/caustic agents
Tongue lacerations may be caused by bite marks

Question 30

Why do frenum tears occur?

Answer 30

Non-accidental trauma
–slap/punch to mouth
–forced feeding with spoon, pacifier, bottle nipple, forced oral sex
Any non-abulatory child with a frenum tear should be evaluated for abuse

Question 31

What is the definition of dental neglect?

Answer 31

Willful failure of parent to follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection

Question 32

What are the terms of being a mandated reporter?

Answer 32

Required to make a report to child protective services or law enforcement if you suspect abuse/neglect
You do not have to have proof
You do not have to conduct a full investigation
You can’t be held civilly or criminally liable

Question 33

How to make a report?

Answer 33

Name, address and age of victim
Name and address of guardian
Name and address of person you suspect is abusing or neglecting the victim
The reason you suspect abuse or neglect
Any other helpful information
You may report anonymously