signs: physical abuse
- fractures - any # in non-mobile child, rib fractures, multiple fractures (and of different ages)
- bruises - shape of hand, strangulation on neck, wrists/ankles for ligatures, buttocks
- burns - child non-mobile, shape of implement, glove or stocking burn (forced immersion)
- bites
presentation: physcial abuse
consider:
* hx of child
* age and stage of development
* background - past attendances
* delay in presenting
* inconsistent hx from caregivers
ix: physical abuse
- full skeletal survey and repeat in 1-2 weeks
- body map
- coagulation screen
- look for #, burns and scalds
- look for head and neck trauma (extradural = direct trauma, subdural = shaking)
- document findings
things to rule out: physical ause
- coagulation disorder
- mongolian blue spots
- osteogenesis imperfecta (blue sclera and Wormian bones in skull sutures)
presentation: sexual abuse
- child aware of things beyond their years
- pregnancy
- STI with no clear reason
- vaginal or rectal bleeding
behavioural signs: sexual abuse
- soiling
- secondary enuresis
- self harm
- sexualised behaviours
- poor school performance
ix: sexual abuse
- STI screening
- forensic swabs of body, clothing and bedding for semen
signs of emotional abuse: babies
- apathetic
- delayed development
- non-demanding
sings: emotional abuse in toddler/pre-school child
- violent
- apathetic
- fearful
signs: emotional abuse in children
- wetting
- soiling
- relationship difficulties
- non-attendance
- anti-social behaviour
signs: emotional abuse adolescents
- self-harm
- depression
- oppositional
- aggressive
- delinquent behaviour
signs: neglect
- consistently misses medidcal appointments
- lacks needed medical/dental care or immunisations/lasses
- seems ravenously hungry
- dirty
- inadequate clothing
induced illness: children
when parent (usually mother) causes harm to children
* multiple unexplained illnesses/admissions
* symptoms only occur in carers prescence
* not substantiated clinical findings
may involve:
* verbal fabricatin
* induction of illness - suffocation or poisoning
rx: abuse
- injuries carefully noted, measured, recorded on body map and photographed
- if abuse suspected - decide if child needs immediate protection
- if treatment not necessary but home unsafe - foster home
- consider other siblings and their safety
