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3Child-Abuse+shaken baby syndrome fmdpdf
- 1. Child Abuse DR. NOUHHAMDAN
- 2. Definitions: Child maltreatment: isany act, intentional or not, that results in harm, the potential for harm, or the threat of harm to a child. The failure to provide child’s needs or to protect a child from harm or potential harm .Child maltreatment can be by a parent, a caregiver or an authorized custodian of the child, such as a coach, teacher Abuse (acts of commission), Neglect (acts of omission) Physical abuse: Intentional injuries to a child by a caregiver that result in bruises, burns, fractures, lacerations, punctures, or organ damage; also may be accompanied by short- or long-term emotional consequences Psychological abuse: Intentional verbal or behavioral acts or omissions that result in adverse emotional consequences—, withholding emotional responsiveness, isolating, terrorizing
- 3. Sexual abuse: isthe involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society Factitious disorder: Intentionally giving poisons or toxins, or any other deceptive action to simulate a disorder
- 6. Consequences: Failure-to-thrive (FTT)—nutritionalneglect is most common cause of underweight infants (>50% of all cases of FTT) Developmental delay Learning disabilities Physical disabilities Death
- 7. Incidence And Prevalence: (WHO) 20% of women and 5-10% of men report being sexually abused as children. 25-50% of all children report being physically abused.
- 8. Risk Factors Higher likelihoodof abuse with: Caregivers have history of abuse or violence Young parental age Closely spaced pregnancies Lower socioeconomic status
- 9. Substance abuse Single parent (mother) Mentally retarded child Preterm, low-birth-weight infants
- 10. Physical Abuse: A2-year-old boy presents to the emergency department with a skull fracture that the mother states the child acquired after falling from a sofa onto a carpeted floor. During the physical examination the child is alert. He is noted to have old bruising on the buttocks and back, as well as a cigarette burn on his palm. The mother states that the child “falls a lot” and is always touching things he should not.
- 11. When to suspect?? Injury is unexplained Injury is incompatible with the history given or with child’s level of development There are no reports of death or serious brain injury from witnessed falls <10 feet.
- 12. Clinical features : Bruises Fractures Burns Intentional head trauma Intra-abdominal injuries
- 13. Bruises: Most common Shape of injury suggests object used—suspect with bilateral, symmetricinjuries Staging–bruises in various stages are not compatible with a single event Consider cultural issues, e.g., coining, cupping
- 20. Bites: 1or 2arches Child bite < 2.5 cm Adult bite > 2.5 cm Animal bite smaller distance B/w 2 arches + deeper
- 23. Don’t get confused!! Birthmarks mongolian spots Henoch-Schönlein purpura
- 24. Fractures: Rib, metaphyseal, and skull fractures are most common Femoral and humeral fractures in nonambulatory infants are also highly suggestive for abuse Multiple fractures in various stages of healing are suggestive of abuse
- 26. Dx Osteopenia ofprematurity Osteogenesis imperfecta Metabolic and nutritional disorders (e.g., scurvy, copper deficiency, rickets) Osteomyelitis Congenital syphilis Neoplasia.
- 27. Burns: Cigarette burns→ circular, punched-out lesions of uniform size
- 28. Immersion burns(most common in infants) – Glove-stocking pattern of extremity
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- 31. – Dipping intobathtub water: ° Demarcation is uniform and distinct ° Flexion creases spared ° Hands and feet spared ° Incompatible with falling into tub or turning on hot water while in tub Hot objects
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- 35. Abusive head trauma(AHT): ‘ shaken baby syndrome ‘ Definition : inflicted cranial, cerebral, and spinal injuries resulting from blunt force trauma, shaking, or a combination of forces . Injuries elsewhere—skeletal and abdominal—should be ruled out
- 36. Abusive head trauma (AHT): The classic injury pattern that is associated with shaking includes diffuse unilateral or bilateral subdural hemorrhage, diffuse multilayered retinal hemorrhages, and diffuse brain injury
- 37. Subdural hemorrhage Subduralhemorrhages are significantly associated with abusive head trauma, occurring almost three times more frequently in abused children than patients with serious unintentional head trauma Alteraion in level of consciousness, seizure, coma
- 38. Dx Arteriovenous malformations Coagulopathies Birth trauma Tumor Infections
- 39. Retinal hemorrhages Importantmarker of AHT Eye examination by a pediatric ophthalmologist The mechanism is likely repeated acceleration–deceleration as a consequence of shaking
- 40. Retinal hemorrhages more than one layer multiple periphery (outsidethe posterior pole)
- 41. Dx NSVD, 25%of term neonates may have retinal hemorrhages (lower with CS, higher with vacuum assisted delivery) - Posterior pole and intraretinal - 80% resolve by 10 days, 100% by 6-8 wk Coagulopathies Retinal diseases Carbon monoxide poisoning
- 43. Skull fractures Skullfractures are common in abuse No specific pattern of skull fracture that is diagnostic of abuse
- 44. Abdominal trauma: 2ndMost common cause of death Recurrent vomiting, abdominal distension, absent bowel sounds, localized tenderness, shock Bruising of the abdominal wall is unusual May rupture liver or spleen Pancreatic pseudocyst may occur weeks or months later Laceration of small intestine Intramural hematoma → temporary obstruction Free air
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- 46. fractures: - Skeletalsurvey—when you suspect abuse in child <2 years old - >2 years, appropriate film area of injury, complete survey not usually required
- 47. Repetitive injuries mayprolong categories 1, 2, 5, and 6.
- 48. AHT: - CTscan ( initial test) - MRI (best obtained 5-7 days after an acute injury) - Ophthalmologic examination
- 49. Abdominal trauma: -Urine and stool for blood - Liver and pancreatic enzymes - Abdominal CT scan
- 50. Medical child abuse(MCA) Factitious Disorder A parent, typically a mother, simulates or causes disease in her child.
- 51. parent falselypresents a child for medical attention - fabricating a history, such as reporting seizures that never occurred - Signs or symptoms may also be manufactured, such as when a parent smothers a child - Alters laboratory samples or temperature measurements.
- 52. Risk Factors Theyfrequently have a personal history of factitious or somatoform disorder, deprivation or abuse during childhood, self-harm, and alcohol or drug abuse. Characteristics such as having extensive medical knowledge, exhibiting calm during otherwise stressful medical events, being a medical provider,
- 53. A parentmay directly cause a child’s illness by exposing a child to - Medication - infectious agent (e.g., injecting stool into an intravenous line) - toxin
- 54. CLINICAL MANIFESTATIONS Bleedingis a particularly common presentation: - This may be caused by adding dyes to samples, adding blood (e.g., from the mother) to the child’s sample - Giving the child an anticoagulant (e.g., warfarin).
- 55. Seizures area common manifestation: -With a history easy to fabricate -The difficulty of excluding the problem based on testing. -A parent may report that another physician diagnosed seizures -Seizures may be induced by toxins, medications
- 56. Apnea: -The observationmay be falsified or created by partial suffocation -A history of a sibling with the same problem, perhaps dying from it
- 57. Gastrointestinal: Forced ingestionof medications such as - ipecac may cause chronic vomiting - laxatives may cause diarrhea