child abuse dr. mansour alqurashi
DESCRIPTION
Session Objectives At the end of this session, participants will be able to: 1. To detail the epidemiology and long term effects of child abuse and neglect 2. To review the role of pediatrics in the primary prevention of child abuse and neglect 3. To learn specific office based strategies for the primary prevention of child abuse and neglectTRANSCRIPT
Child Abuse Dr. Mansour Alqurashi Session Objectives At the end
of this session, participants will be able to: 1. To detail the
epidemiology and long term effects of child abuse and neglect 2. To
review the role of pediatrics in the primary prevention of child
abuse and neglect 3. To learn specific office based strategies for
the primary prevention of child abuse and neglect Child Abuse Abuse
is a violation of an individuals human
and civil rights by any other person or persons Abuse and neglect
are forms of maltreatment of a child.Somebody may abuse or neglect
a child by inflicting harm, or by failing to act to prevent harm.
Children may be abused in a family or in an institutional or
community setting, by those known to them or, more rarely, by a
stranger.They may be abused by an adult or adults, or another child
or children. Children Rights There is clear evidence that child
abuse is a global problem. It occurs in a variety of forms and is
deeply rooted in cultural, economic and social practices. Before
defining child abuse its crucial to get informed about childrens
rights in the first place. RIGHTS BASED APPROACH
Non-discrimination Best interests of the child Life, survival and
development Respect of the views of the child PRIORITIES Right to
Education
Access to quality, free, compulsory primary education.
Non-Discrimination in access to education (gender gap). Right to
leisure, recreation and cultural activities. Right to Health Access
to quality health services
Rights of children with disabilities Adolescents and reproductive
health knowledge Right to benefit from social security Right to an
adequate standard of living Right to Special Protection
Protection from all forms of exploitation (economic, sexual).
Violence against children (physical, psychological & sexual).
Female Genital Mutilation & early marriage. Torture and
deprivation of liberty for juvenile in conflict with the law
Hazardous occupations. Smoking, substance abuse, and trafficking.
Street children. Child Abuse Definition:
Mental or emotional injury affecting growth, development, or
psychological function Causing or permitting the child to be in a
situation in which the child sustains injury or increases the risk
for injury Failure to make a reasonable effort to prevent harm
Harmful sexual conduct Failure to prevent harmful sexual conduct
Encouraging the child to engage in such conduct Child abuse
Definition:
Placing a child or failing to remove a child from a harmful
environment Failure to seek appropriate care Failure to provide
appropriate care Failure to arrange appropriate care when returning
home Another Definition Any behavior directed toward a child that
endangers or impairs a childs physical or emotional health and
development How to help Report Believe children Screening?
Prevention Role of Physician in Child Abuse
Protect Suspect Inspect Collect Respect Protect... Patient/family
and team safety are paramount.
Protect the life of the patient as well as as much evidence as
possible. Suspect... Does the history fit what you are seeing-
either injury or illness? Is this a repeat patient or family member
of a repeat patient? Is there a history of family violence?
Collect... Collect as much evidence as possible, including
physical and trace evidence information Respect... Respect the
right to refuse Respect diversity
Respect privacy Abuse is not always obvious
Difficulties and Challenges Abuse is not always obvious -
Perpetrators may not admit, acknowledge or recognise - Victims may
not disclose (or recognise) - Professionals may not notice
Different and changing views about what constitutes Abuse Privacy
and Family Life Interference or Protection General
considerations
Suspect abuse with any unusual physical or psychological complaint
Is the injury consistent with the history? Identify signs and
symptoms of suspected abuse Maintain a safe environment for the
child Understand legal requirements for reporting suspected child
abuse General considerations (cont)
Case management should be a team approach Physicians and nurses
Social services Law enforcement agencies Document, document Types
of Abuse Physical Abuse Physical abuse is any non-accidental injury
to a child under the age of 18 by a parent or caretaker.These
injuries may include beatings, shaking, burns, human bites,
strangulation, or immersion in scalding water or others, with
resulting bruises and welts, fractures, scars, burns, internal
injuries or any other injuries. Physical Abuse (cont.) The term
battered child syndrome was coined to characterize the clinical
manifestations of serious physical abuse in young children. 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. Another form is the The shaken infant. Shaking is a
prevalent form of abuse seen in very young children (less than 1
year). Most perpetrators of such abuse are males. Intracranial
haemorrhages, retinal haemorrhages and chip fractures of the childs
extremities can result from very rapid shaking of an infant.
Corporal Punishment Corporal punishment of children --- in the form
of hitting, punching, kicking or beating --- is socially and
legally accepted in most countries. In many, it is a significant
phenomenon in schools and other institutions and in penal systems
for young offenders. Rates of harsh or moderate forms of physical
punishment (WHO) WORLD REPORT ON VIOLENCE AND HEALTH (2002) Rates
of verbal or psychological punishment (WHO) WORLD REPORT ON
VIOLENCE AND HEALTH (2002) Identifying Physical Abuse... By the
Doctor
Normal childhood development Conditions that may be confused with
abuse Unintentional vs intentional injury Conditions that Mimic
Child Abuse
Bruising Mongolian spots Congenital coagulopathy Birth trauma
Accidental trauma Fractures Osteogenisis Imperfecta Rickets Scurvy
Syphilis Copper Deficiency- Menkes kinky hair syndrome Recognizing
Abuse Injuries...
Skin Injuries TEARS Human Bite Marks Hair Loss Falls Head, facial,
oral injuries Shaken baby Syndrome Skin Marking Normal Trauma
Protected areas
Extensor surfaces to arms and legs Protruding bony surfaces of face
Protected areas Inner arms Throat Abdomen Lower back Inner thighs
Skin Marking Dating Bruises?
Depth, skin color, location, amount of bleeding in the tissue
Fresh: red/purple -> blue -> brown -> yellow/green Cannot
effectively date bruises. Document location, size, shape, color
Bruises Generally speaking:
fresh injury is red to blue 1-3 days deep black or purple 3-6 days
color changes to green and then brown 6-15 days: green to tan to
yellow to faded, then disappears The younger the child the quicker
the color resolves. Bruises Common to all children
Accidental injuries typically occur on the forehead and extremities
Bruising can occur secondary to medical conditions Leukemias
Idiopathic thrombocytopenia purpura (ITP) Coagulopathies (bleeding
disorders) Suspicious injuries Occur in different planes of the
body Different stages of healing Central distribution Injuries to
the back Pattern injuries If youre not old enough to cruise, youre
not old enough to bruise
Bruising and other soft tissue injury is extremely uncommon in
children younger than 6 months of age and increases in frequency as
children becomes older and more mobile Any bruising on an
infant