Peds 3: Abusive injuries and trauma in children

most common form of child abuse
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important factors in identifying abuse-detailed history of the injury -developmental history (can they developmentally have suffered the injury that is reported) -is there an explanation for the injury -could the injury have been avoided by better care and supervisionred flags with child abuse- No history of denial of trauma despite severe injury - Implausible history for degree of type of injury - Unexplained or excessive delay in seeking care - Injury attributed to in home resuscitation efforts - Caregiver histories that change or conflict with others Severe injury explained as self-inflicted or blamed on other young childrenlifts chest off table2morolls front to back4mosits unsupported6mocrawls8mowalks alone12mogoes up steps21 momost common involved organ in children with accidental and intentional injuriesthe skinmost common presenting feature of physical abusebruisingincidence of head or facial injuries in physical abuse patients50% of physical abuse patients have head or facial injuriescommon physical abuse cutaneous injuries路 Ears, cheeks, and temporal and parietal areas 路 Hemorrhages around the ear and ear lobe 路 Injury to the eye without injury to the nosecharacteristics of accidental bruising路 Bruises are generally small (10-15mm in size) o Prevalence and number increase with motor development 路 Parents generally able to give explanations for 路 Location is important - accidental often over bony prominence o Knees and shins common o Over bony prominences, front of the body, foreheadUncommon locations for accidental bruisingTEN: torso, ear, neck also buttockswhen is bruising suggestive of abuse- Bruising in children who are not independently mobile (incidence is <1%) - Bruising in babies - Bruises that are away from bony prominences - Multiple bruises - Bruises of uniform shape - Bruises that carry the imprint of the implement used or a ligaturemost common type of intentional burnsscald burnspercent of all burns that are due to abuse10%characteristics of scald burns that are indicative of abuse路 Lower body without head or neck involvement 路 Skin fold sparing (child is holding themselves together) 路 Central sparing of buttocks (sitting down in the tub)type of fracture that is highly suggestive of abuserib fractures however fx from abuse have been described in virtually every boneabusive head traumaaka shaken baby syndrome. caused by vigorous shaking and rotational motion with or without impact leading to subdural hemorrhage (tearing of briding veins) and retinal hemorrhages.common injures associated with abusive head trauma in children-subdural hemorrhage on CT -retinal hemorrhages -fractures on skeletal surveypresentation of child with severe abusive head trauma路 Respiratory compromise 路 Apnea 路 Seizuresnon-specific presentation of child with abusive head trauma路 Vomiting 路 Crying 路 Lethargy 路 Enlarging head circumference 路 Bruising in non-ambulatory childcharacteristics in children under 3 that are suggestive of abuse-no history of trauma -persistent neuro impairment and a history of a low impact fall -hx of out of hospital CPR -changing historynursing guidance to prevent abuse in children-Crying patterns and when to seek medical help -Coping strategies -dangers of shaking the infantPURPLE crying pneumonicPeak of crying Unexpected Resists soothing Pain-like face Long lasting Eveningwhat is meant by purple cryingrefers to a time period when some babies begin crying more and may be hard to settle. This usually starts at about 2 weeks of age and peaks at 8 weeks. It usually ends by 12 weeks of agedo nurses need definitive evidence to report an abuse caseOnly need a "reasonable cause to suspect"therapeutic communication techniques when it comes to communicating with an abused childo "Thank you for telling me that" o "I believe you" o "This is not your fault" o "You have options" o Open-ended questions o A patient, calm, non-judgmental approach o Get on their levelwhat should be avoided when speaking to abuse victims-making promises -making the patient repeat their story -using confusing clinical terminology -"allegedly" -- instead use "patient states that..."How is abuse related to societal systems?o Consider a family's experiences, beliefs, history o Consider how prejudice influences the existing systems o How are clinic/hospital settings intimidating and retraumatizing for young people?