Dr. Sarah Zia presented on child abuse, defining it as any act or condition that deprives children of their rights and optimal development. She discussed the various types of abuse including physical, sexual, emotional abuse and neglect. She also covered risk factors, signs and symptoms, long term health impacts, and the importance of thorough medical evaluation for suspected victims of abuse. Proper documentation and reporting to authorities is crucial to protect children and ensure their needs are met.
Child abuse and neglect is a major health problem all over the world. In most of the cases the perpetrator is someone whom the child or the parent knows. April has been designated Child Abuse Prevention Month in the United States since 1983. U.S. President Barack Obama continued that tradition by declaring April 2009 Child Abuse Prevention Month.
Behavioral Management Technique For Patient With Special Needs DrGhadooRa
done by : ( ABCD'S &G )
alaa ba-jafar
abrar alshahranii
sahab filfilan
nada alharbi
shahd rajab
Ghadeer suwaimil
I hope that you enjoy and you benefit❤
About Child abuse, we have many problems today in the community which wouldn't be there if children were protected and given their right, lets all remember ''protecting the kid is protecting the future world''
Child abuse or child maltreatment is physical, sexual, or psychological maltreatment or neglect of a child or children, especially by a parent or other caregiver. Child abuse may include any act or failure to act by a parent or other caregiver that results in actual or potential harm to a child, and can occur in a child's home, or in the organizations, schools or communities the child interacts with.
Child abuse and neglect is a major health problem all over the world. In most of the cases the perpetrator is someone whom the child or the parent knows. April has been designated Child Abuse Prevention Month in the United States since 1983. U.S. President Barack Obama continued that tradition by declaring April 2009 Child Abuse Prevention Month.
Behavioral Management Technique For Patient With Special Needs DrGhadooRa
done by : ( ABCD'S &G )
alaa ba-jafar
abrar alshahranii
sahab filfilan
nada alharbi
shahd rajab
Ghadeer suwaimil
I hope that you enjoy and you benefit❤
About Child abuse, we have many problems today in the community which wouldn't be there if children were protected and given their right, lets all remember ''protecting the kid is protecting the future world''
Child abuse or child maltreatment is physical, sexual, or psychological maltreatment or neglect of a child or children, especially by a parent or other caregiver. Child abuse may include any act or failure to act by a parent or other caregiver that results in actual or potential harm to a child, and can occur in a child's home, or in the organizations, schools or communities the child interacts with.
It is an important topic in today's world. today it has become important to educate our children about child abuse. read this and get information about the child abuse and why it is a hinderence in our country's progress.
In honor of National Public Health Week, APHA, CDC's National Center for Injury Prevention and Control, and the Georgia Public Health Association hosted a dynamic panel discussing the importance of child maltreatment prevention. Prominent leaders in the field discussed current research, effective programs and the return on investment of child maltreatment prevention efforts.
Presentation by: Jenelle Shanley, PhD, Institute of Public Health, Georgia State University
SafeCare Website: http://publichealth.gsu.edu/968.html
The World Health Organisation (WHO) has
defined ‘Child Abuse’ as a violation of basic
human rights of a child, constituting all forms of
physical, emotional ill treatment, sexual harm,
neglect or negligent treatment, commercial or
other exploitation, resulting in actual harm or
potential harm to the child’s health, survival,
development or dignity in the context of a relationship of responsibility, trust or power. ‘Child
Neglect’ is stated to occur when there is failure
of a parent/guardian to provide for the development of the child, when a parent/guardian is in
a position to do so (where resources available
to the family or care giver; distinguished from
poverty).
Child maltreatment is a huge global problem with a serious impact on the victims’ physical and mental health, well-being and development throughout their lives and by extension, on society in general.
(WHO & INTERNATIONAL SOCIETY FOR PREVENTION OF CHILD ABUSE AND Neglect)
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. IS THIS ABUSE?
• A girl is slapped for screaming at her mother; the slap
stings, but leaves no lasting mark or pain.
• A boy is punished in a way that requires stitches.
• A father burns his daughter’s palms with a lighted
cigarette when he finds her smoking.
• A mother is careless and spills scalding coffee on her
daughter, who is seriously burned.
• A boy’s arm is broken after wrestling with his father for
sport.
• A girl is spanked so hard she is badly bruised, but the
father says he did not mean to hurt her.
• A boy is grounded for a week for a minor offense.
• A father takes away his son’s driver’s license for getting a
parking ticket.
• A young mother was asked to get help and get off drugs
but her baby was born addicted to drugs
3. DEFINITION
• Any act of commission or omission by
individuals, institutions or society as a whole
and any conditions resulting from such acts or
inaction, which deprive children of equal
rights and liberties, and/or interfere with their
optimal development, constitute by
definition, abusive or neglectful acts or
conditions.
4. CHILD RIGHTS
• Main features of child rights are:
1. Right of survival and development
2. Right to have a name and nationality
3. Right of freedom of expression
4. Right of freedom of thought
5. Right of health and medical care
6. Right of education
7. Right of having a good standard of living
8. Right of leisure, recreation and cultural activities
9. Right of administration of juvenile justice
5. History of child abuse
• 1860 - Ambroise Tardieu
– French physician
– Medical, psychiatric, social and demographic features of child abuse as a
syndrome
• 1946 – Dr. Caffey (pediatric radiologist)
– Subdural haematoma and long bone fractures inconsistent with accidental
injury
• 1953 – Silverman
multiple fractures resulted from intentional trauma and not organic disease, as
commonly thought.
• 1962 – Dr. C. Henry Kempe
– “The battered child syndrome” in JAMA
– 447 abuse cases reported in 1962
• (2.9 million cases reported in 1992)
6. Shaken Baby Syndrome
• Shaking is a prevalent form of abuse seen in very young children.
• The majority of shaken children are less than 9 months old.
• Most perpetrators of such abuse are male, though this may be more a
reflection of the fact that men, being on average stronger than
women, tend to apply greater force, rather than that they are more prone
than women to shake children.
• Intracranial hemorrhages, retinal haemorrhages and small ‘‘chip’’
fractures at the major joints of the child’s extremities can result from very
rapid shaking of an infant.
• They can also follow from a combination of shaking and the head hitting a
surface.
• There is evidence that about one-third of severely shaken infants die and
that the majority of the survivors suffer long-term consequences such as
mental retardation, cerebral palsy or blindness.
7. Battered Baby Syndrome
• One of the syndromes of child abuse is the
‘‘battered child’’.
• This term is generally applied to children
showing repeated and devastating injury to the
skin, skeletal system or nervous system.
• It includes children with multiple fractures of
different ages, head trauma and severe visceral
trauma, with evidence of repeated infliction.
• Fortunately, though the cases are tragic, this
pattern is rare.
8. Münchausen syndrome by proxy
• Münchausen syndrome by proxy (MSbP or MBP)
is a controversial label for a behavior pattern in
which a caregiver deliberately
exaggerates, fabricates, and/or induces
physical, psychological, behavioral, and/or mental
health problems in those who are in their care.
• With deception at its core, this behavior is an
elusive, potentially lethal, and frequently
misunderstood form of child abuse or medical
neglect that has been difficult to define, detect
and confirm.
9. PLAY ACTIVITIES THAT ARE HAZARDOUS:
• Tossing a small child into the air
• Jogging while carrying an infant on the back or
shoulders
• “Riding a horse” – bouncing on the knee
• Swinging the child around by his/her ankles
• Spinning a child around
WARNING: If this happens take child to Emergency Room
immediately. The child can be treated.
10. Epidemiology
Child abuse is a world-wide phenomenon and can
affect children of all ages
It is difficult to gain a true estimate of child abuse
due to the hidden nature of the problem.
In industrial countries it is estimated that:
• 4% to 16% of children are physically abused,
• around 10% are neglected or emotionally abused,
• 15% of boys and 35% to 40% of girls are exposed to sexual
abuse.
• Around 80% of child abuse is perpetrated by care takers or
parents
11. Children less than 12 years of age are the most abused at
36.4%, followed by children between 15 and 18 years of
age at 36%, and then children between 12 and 14 years old
Orphans children are more vulnerable to abuse than others
at 70%, followed by children of separated parents at
58%, and then children of divorced parents are subject to
physical abuse at 42
This study has also indicated that child abuse happens
more in poor families and those under poverty threshold
14. Parental characteristics
• Low self-esteem / depression
• Abused as a child
• Poor impulse control
• Substance abuse
• Teenage parent
• Unrealistic expectations of child behavior
• Negative view of themselves & their children
15. Triggering situations
• Crying baby
• Child’s misbehavior
• Discipline gone awry
• Argument, family conflict
• Toilet training
16. Social/Situational Stresses
• Working parents
• Isolation
• Family/domestic violence
• Non-biologically related male in the home
• Poverty
• Unemployment/financial problems
• Single parent
• Animal abuse
17. TYPES OF CHILD ABUSE
• Physical abuse
• Emotional abuse
• Sexual abuse
• Neglect
18. PHYSICAL ABUSE:
Non-accidental injury of a child that leaves
marks, scars, bruises, or broken bones.
Behavior indicators:
Aggressive or
withdrawn
Afraid to go home
Lying
Layered clothing
19. Health consequences of Physical abuse:
• Abdominal/thoracic injuries
• Brain injuries
• Bruises and welts
• Burns and scalds
• Central nervous system injuries
• Disability
• Fractures
• Lacerations and abrasions
• Ocular damage
20. SEXUAL ABUSE:
Fondling, sexual intercourse, assault, rape, incest, child
prostitution, exposure and pornography
Behavior indicators:
• Inappropriate sexual knowledge
• Abrupt change in personality
• Withdrawn
• Poor peer relationships
• Sleep disturbances
• Regressive behavior
21. Health consequences of Sexual abuse:
• Reproductive health problems
• Sexual dysfunction
• Sexually transmitted diseases, including
HIV/AIDS
• Unwanted pregnancy
• Infertility
22. EMOTIONAL ABUSE:
Rejecting, terrorizing, berating, ignoring, and
isolating, that is likely to cause serious impairment of the
physical, social, mental, or emotional capacities of the
child.
Behavior indicators:
• Failure to thrive
• Speech disorders
• Lags in physical development
• Habit disorders, conduct disorders
• Sleep disorders or inhibition of play
• Aggressive or passive
23. NEGLECT:
Failure of parents or caretakers to provide needed, age appropriate
care. Including food, clothing, shelter, protection from harm,
supervision appropriate to the child’s development, hygiene, and
medical care.
Behavior indicators:
• Hunger
• Poor hygiene
• Excessive sleepiness
• Lack of appropriate supervision
• Unattended physical problems or
medical needs
• Abandonment
• Inappropriate clothing for weather
conditions
24. Psychological and behavioural health consequences:
• Alcohol and drug abuse
• Depression and anxiety
• Developmental delays
• Eating and sleep disorders
• Feelings of shame and guilt
• Hyperactivity
• Poor relationships
• Poor school performance
• Poor self-esteem
• Post-traumatic stress disorder
• Psychosomatic disorders
• Suicidal behaviour and self-harm
25. Other longer-term health consequences
• Cancer
• Chronic lung disease
• Fibromyalgia
• Irritable bowel syndrome
• Ischaemic heart disease
• Liver disease
26. Medical Evaluation of
Victim of Suspected Abuse
• History
• Physical Examination
• Laboratory and Radiologic Studies
• Differential Diagnosis
• Documentation
27. HISTORY
Taking history from a parent / caretaker
• Children should not be present!!
• Interview adults who are present separately
28. Taking a history from the caretaker/parent
• Who?
• What?
• When?
• Where?
• Why?
• How?
29. Suspicious History
• History inconsistent w/physical examination
• Magical injury
• Sibling blamed
• History changes with time or varies between
caregivers
• Delay in seeking care
• Self-inflicted injury incompatible w/development
• Poor Parent Child Interaction
• History of abuse in parents childhood
• Stress or crisis in the family or parents
• Unrealistic expectations of parents for the child
30. Suspicious Behavioral Complaint
– Depressed, angry, withdrawn, other changes
– School performance
– Aggressive behavior, temper tantrums
– Behavior with family, pets/animals
– Detailed information about adult sexual
behavior
– Explicit demonstration of sexual play
– Excessive sexual curiosity
– Bedwetting
– New risk taking behaviors
31. Physical Examination
• Therapeutic and diagnostic
• Complete head to toe evaluation
• Growth parameters
• Child behaviour
• Must look at all skin surfaces
– Remove ALL clothing (lack of clean clothing and poor
personal hygiene indicate neglect)
– Description of all skin findings (abrasions, alopecia, bites,
bruises, burns, dental trauma, fractures, lacerations,
ligature marks, or scars)
– Ears, Neck, Mouth.
– Genitalia and anal region.
32. Physical Exam
“Red Flags”
• Most common indication of physical abuse
• Occurs in >50% of abused children
• Bruises are uncommon in infants
< 6 months.
– “Those who don’t cruise rarely bruise.”
• Two characteristics separate abusive from accidental
bruises:
LOCATION
PATTERN
37. Differential Diagnosis of Bruises
• Erythema multiforme – palms/soles initially, extension
upwards, can become purpuric
• ITP, other coagulopathies
• Henoch-Schönlein purpura – normal platelets – IgA mediated
vasculitis – often involves buttocks and lower extremities
• Cultural practices
– Cao gio (coining)
– quat shat (spooning)
– cupping
38. Differential Diagnosis of Burns
First Degree
Cellulitis, erysipelas
Sunburn
Contact dermatitis
Diaper rash
Drug reaction
40. Differential Diagnosis of Fractures
• Minor falls
– Do not cause fractures in most instances
– Studies show very low incidence of fractures from short
falls
• Obstetrical/birth trauma
– usually produces only humeral and clavicular fractures
– no rib fractures
• Prematurity
– Osteopenia can lead to fractures
41. Differential Diagnosis
Accidental Fractures
Toddler’s Fracture
Accidental oblique fracture of tibia in children
9 months to 3 years of age
Often are unwitnessed injuries of trivial
nature
Limp, refusal to bear weight
Localized tenderness may be present, no
swelling
X-rays often negative
43. Management
• Child abuse is often an ongoing process. If the diagnosis of
child abuse is being considered, the parents and/or carers
must be informed of all relevant investigations and referrals
being made.
44. • Reporting to authorities (Documentation)
Doctors are required to share information with
other agencies, and with social work and law
enforcement bodies, to ensure that the child's needs
are met and he or she is protected from harm.
Doctors are required to provide written reports
for use in multi-disciplinary meetings, police
investigations, and civil or criminal courts, and may be
required to appear as witnesses (of fact or as experts)
in court.
Accurate reporting also involves photographs of
visible injuries and forensic swabs (e.g., of bites).
45. • Counselling
Counselling should be considered following full
investigation and immediate management of injuries.
Cognitive behavioural therapy is increasingly
used, but must be individualised. Family therapy is
also indicated in certain situations to support other
members of the family.
46. • Management of injuries/specialist consultation
Individual injuries should be managed as
appropriate, irrespective of whether they are caused
by abuse or accident.
However, where abuse is considered, the
physician should ensure that an appropriate search
for additional or hidden injuries is also carried out.
47. HOW TO REACT IF A CHILD TELLS YOU
ABOUT ABUSE:
• Listen, do not interfere, assume or interrogate.
• Reassure the child that he/she has done the right thing by
telling you and that you are glad they told you.
• Make sure they understand it was not their fault.
• Remain calm and accepting, don’t over react.
• Do not promise not to tell.
• Be honest and tell the child what to expect.
• Reassure them you will do what needs to be done to make
sure it doesn’t happen again.
• Determine the child’s needs for safety.
48. Conclusions
• Child abuse is very common
• Often missed by clinicians
• Must have high index of suspicion
• Mandated reporters must report suspicion of abuse
• Complete careful histories and examinations
• Document, document, document!
• Avoid the misdiagnosis of abuse