What are the characteristics of Abusive Skin Injuries?
- Different planes of body
- Different healing stages
- Central distribution
- On back
- Pattern injuries
Where do accidental injuries most commonly occur?
What medical conditions usually cause bruising?
Leukemias, Hemophilia, Moxibustion, Cao Gao, Ehlers-Danlos syndrome, Mongolian spots, ITP, coagulopathies (bleeding disorders)
What are the most common types of bruises in abused children?
What is considered when protecting a bite mark for analysis?
- Dont wash area
- Dont medicate area
- Dont cover or bandage area
- Dont use site for IV access
- Dont place monitor leads on or near site
- Swabs for DNA may be helpful
Describe some examples of Pattern Marks?
Hand marks, switches/paddles, mini-blind rods, fly-swatter, belts, belt buckles, ropes, cords, shoes, kitchen tools (look marks, flip-flop imprints
What are the most common burns in small children?
Scald burns (immersions)
What are the characteristics of an abusive burn?
- Distinct lines of demarcation
- "Stocking or glove" pattern
What are the characteristics of an Accidental Burn?
- Irregular pattern
- "Splash/Drip" mark
What is the extent of a burn depended on?
- Water temperature (117 F)
- Duration of exposure
- Presence/absence of clothing or material
- Area of body exposed
What type of fracture is diagnostic of abuse unless proven otherwise?
Rib Fractures (result of direct trauma to the chest)
What are the most common types of blunt force traumas to the chest?
- Rib fracture
- Pulmonary contusion (rare)
- Cardiac contusion (rare)
What are the most common blunt force traumas to the abdomen?
- Duodenal hematoma
- Splenic or liver lacerations/contusions
- Bowel rupture
At what age are abusive fractures most common?
18 months and younger
What fractures should you be extremely concerned about in relation to abuse?
- Posterior rib fracture
- Multiple fractures of different stages
- Metaphyseal fracture
Name fractures that are highly specific of abuse
- Classic metaphyseal "chip" fractures/lesions
- Rib fractures, especially posterior
- Scapular fractures
- Spinous process fractures
- Sternal fractures
Name fractures that are moderately specific of abuse?
- Multiple fractures, especially bilateral
- Fractures of different ages
- Epiphyseal separations
- Vertebral body fractures and subluxations
- Digital fractures
- Complex skull fractures
Name fractures that are common but are low in specificity for abuse?
- Subperiosteal new bone formation
- Clavicular fractures
- Long bone shaft fractures
- Linear skull fractures
A disorder that causes fragile bones?
- Causes fragile bones
- Genetic defect in collagen production
- Dominant (classical) IO has too little type I collagen or poor quality
- Recessive OI interference in collagen production
what type of falls are not fatal or life-threatening?
Simple short falls (off couches, chairs, or down stairs)
When are falls fatal/life-threatening?
When a child falls more than 40 feet to have serious/life-threatening brain injuries!
What is the leading cause of death in children under 5 years old?
head injuries (They may NOT be evident externally)
when are most head injuries of abusive nature?
when in babies under 1 years old
Shaken Baby Syndrome
A form of abusive head trauma that occurs when a frustrated caregiver violently "shakes" or "shakes" and "slams" a child's head against an object. Usually to stop them from crying or to get a child to respond to the expectations of the caregiver. There are often no outward signs of abuse. usually injury to eyes and brain
What are the most common triggers for SBS?
- Toilet training
- Feeding problems
Who is at highest risk for being a victim of SBS?
- <5 years of age
- Premature babies
- Special Needs babies
- Babies that are difficult to soothe
- because of the extra care they require and tendency to cry more often
What are the mild S&S that can occur with SBS?
- Poor feeding
What are Severe S&S of SBS?
- Respiratory distress
- Altered consciousness/Coma
About what time do the S&S of SBS occur?
- Moderate - Immediate onset
- Severe/Fatal- immediate onset; No "lucid interval" following AHT incident
- * the child will not be acting "normally" and doing "normal" activities
When are the chances of inflicted head injury highest?
When a young child sustains a serious head injury without an apparent major trauma history, such as MVC, fall from heights greater than 10 feet, etc.
What are the "big 3" diagnostic criteria of SBS/AHT?
- Brain injury/swelling
- Retinal hemorrhage
- Subdural hemorrhage
What are the characteristics of a Subdural Hematoma?
- Small volumes of blood
- Marker for SBS
- Bridging veins tear during abuse
- Decreased oxygen (cerebral hypoxia) heightens brain injury
Describe the profile of a SBS/AHT perpetrator.
- SBS is a crime of ISOLATION
- Typically only 1 perpetrator who knows what happened to the child
- There is NO SPECIFIC PROFILE
- PEOPLE shake children
What is the most common type of abusive injury?
- Rib fractures
- Posterior (back) fractures highly likely to be abuse
- CPR does not cause rib fractures in small children
- Accidental is rare, especially if multiple and in different stages of healing
What is needed to evaluate AHT?
- All medical records
- Best evaluated by primary care physician
Identify the characteristics leading to Failure to Thrive?
- Failure to offer adequate calories
- Failure of child to take sufficient calories
- Failure of child to retain sufficient calories
All instances in which the basic needs of children are not met, regardless of cause is?
Failure to thrive (most prevalent form of child maltreatment)
Identify the basic needs of children?
Adequate food, supervision, protection, clothing, health care, education, a stable home, and emotional needs for love and nurturance
______ involves abandoning the child, failing to acknowledge the child, scapegoating the child are examples of ...?
_____ involves keeping the child away from a variety of appropriate relationships is called?
_____ involves threatening or scaring the child is called?
______ involves failing to respond to a child or pretending they are not there?
______ involves encouraging or supporting illegal or deviant behaviors?
disorder where a child feigns disease, illness, or psychological trauma in order to draw attention to themselves
Munchausen Syndrome by Proxy "Factitious illness by proxy"
What are the 5 stages in the process of perpetrators preparing children to be victimized?
What are the phases of disclosure in sexual abuse?
- Disclosure: tentative or active
- Recantation (child no longer holds in the secret)
Name some reasons a child may recant his or her story.
emotional trauma, family disruption, pressure by offender and or family, negative personal consequences, judicial process
List sequence of sexual behaviors as they gradually occur.
- Accidental touching
- Fondling or exposure to genitals
- Oral contact with genitals
- Slight penetration of vagina/anus
What should be performed when there is expected child abuse?
perform a limited anal/genital exam to determine the need for immediate referral to child sexual abuse experts or child advocacy centers
What should be a normal part of all child wellness exams?
Genital/ Anal exam
When should forensics be used in child abuse?
When disclosure is within the last 96 hours