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Categories of abuse
- Physical abuse
- Emotional abuse
- Sexual abuse
- 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.
- 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
- 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
- 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
- Behavior: detached, depressed, hostile, defensive
- Drug affected,
- poor eye contact
- 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