Last Updated on February 23, 2019 by frcemuser

Categories of abuse

• Physical abuse
• Emotional abuse
• Sexual abuse
• Neglect

Risk factors

• History of abuse: Previous history of child maltreatment in the family (health visitors and social workers may have useful information).
• Domestic violence. Also domestic/marital conflict, and history of violent offending in the family.
• Family psychiatric history: Mental health disorders, learning disability, physical illness or disability in the carers.
• Drug or alcohol misuse: Drug or alcohol misuse in the carers – especially if unstable or chaotic drug misuse.
• Unemployment: Housing or financial problems.
• Life-limiting illness: Disability or long-term chronic illness in the child.
• Single parents, especially if immature or unsupported.
• History of animal/pet maltreatment.
• Child or siblings are known to authorities: Children in the care system.
• Some children are vulnerable to being “lost” by the system – for example, where the families are homeless or asylum seekers, or where children are carers or young offenders.

Assessment

History

• History of presenting complain — consistency of injury with the mechanism
• Other injuries sustained
• Past History:? other injuries
• Developmental history
• Social circumstances: socio-economic status, illicit drug dependence, other dependents
• Failure to provide access to appropriate medical care or education(do not administer prescribed medication,failure to attend appointments, failure to engage with immunisations,screening and reviews,Unjustified poor attendance at school)
• Consistencies in mother’s history; correlation with other sources
• Collateral history important. Liaise with GP and other sources

Examination of Child

• Observe the mother’s interaction with the child
• Vital signs & GCS
• Neurological examination including fundoscopy for retinal haemorrhages
• Developmental: physical (height, weight & head circumference) and neurological

General examination:

• • Injuries that dont fit the history
  • Multiple fractures in various stages of healing, or different types of injuries
  • Injuries that are likely to be inflicted
  • Evidence of poor caretaking
  • Sudden onset of altered mental status not attributable to medical illness
  • Any bruising in a child that is not yet cruising
  • Bruising to the pinna, neck, or abdomen
  • Injury to the genitalia
  • bruises
    • Buttocks, trunk, genitals, ears and back of hands.
    • Bilateral, symmetrical or geometric
    • Bruise resembles shape of an instrument (e.g. belt buckle, hand knuckles, spoon)
    • Multiple bruises of various colours on the same area
  • Burns- patterns that mimic objects-especially hot plates, hair straightening irons, steam irons, cigarettes et
  • abusive head injury and may happen by shaking- retinal haemorrhages than subdural haemorrhage therefore look for SDH in a child with retinal haemorrhages

Emotional abuse occurs when an adult harms a childs development by repeatedly treating and speaking to a child in ways that damage the childs ability to feel and express their feelings. Signs include:

• Parent or guardian constantly criticizes the child
• Child shows extremes of behaviour and displays anxiety
• delayed physical, emotional, or intellectual development
• compulsive lying and stealing
• displays feelings of worthlessness
• eating hungrily or hardly at all
• Attention seeking
• reluctance to go home
• rocking, sucking thumbs or self harming behaviour
• fearfulness when approached by a person known to them

Mother

• Behavior: detached, depressed, hostile, defensive
• Drug affected,
• unkempt
• poor eye contact

Management

• Manage the injuries accordingly
• if NAI suspected – safeguard Children
• Inform named professional for child protection in a hospital or a consultant pediatrician
• Refer to the local child social services.
• if a risk of immediate serious harm, inform to the police
• Notify the GP of hospital/A&E attendances

READ: https://patient.info/doctor/safeguarding-children-how-to-recognise-abuse-or-a-child-at-risk