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Child Abuse

Child Abuse. Naminder Sandhu & Dr. Bela Sztukowski September 1, 2011. Video: Infant beat to death by father

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Child Abuse

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  1. Child Abuse Naminder Sandhu & Dr. BelaSztukowski September 1, 2011

  2. Video: Infant beat to death by father BATTLEFORD — A 25-year-old Lloydminster man who “snapped” while changing his infant son’s diaper, fatally injuring the child, has received a prison sentence of 5 1/2 years for manslaughter. APRIL 26, 2011 NEWSCANADA Baby girl savagely beaten by woman before rescue  CHRIS KITCHING, SUN MEDIA FIRST POSTED: WEDNESDAY, SEPTEMBER 2, 2009 Toddler dies in hospital; police to charge Medicine Hat day home worker BY CALGARY HERALD, GLOBAL TV CALGARY JULY 22, 2010 Man in custody after infant slashed in Calgary suburb Six-month-old boy expected to survive attack, now in hospital in stable condition By Jen Gerson, Postmedia News August 14, 2011

  3. Sexual abuse 10% Emotional abuse 19% Physical abuse 31% Neglect 40%

  4. Objectives • Identify suspicious injury patterns • Consider ddx and mimics • Review appropriate investigations • Explore management options • Know your medical and legal responsibilities

  5. Epidemiology Canadian Incidence Study of Reported Child abuse and Neglect, 1998 • 22 investigations/1000 children (2.2%) • 45% of cases confirmed by child welfare workers (9.9 cases/1000)

  6. Who’s at risk?

  7. What and how to ask: the history

  8. Think twice if…. • Sounds crazy but explains injury • Sounds reasonable but doesn’t explain injury • 30 degrees out and “she ran bare feet onto the hot pavement”… but arches of feet also burned!

  9. Consider child’s development! “Those who can’t cruise don’t bruise”

  10. Spectrum of Child Abuse

  11. General assessment • Behavioural indicators • Age appropriate? Regression? • Emotional attachments • School • Drugs • Mood, sleep • Trouble with law • Physical indicators • Hygeine • Growth • Injuries

  12. Case 1: 3 month old colicky, irritable

  13. Abusive head trauma

  14. Which is not in ddx for SDH? • Accidental short fall • Birth trauma • MVC • Minor or no trauma with F13 deficiency • Minor trauma with Marfan • Abusive head trauma • Other: Vit K defic, hemophilia A, vWD, platelet function disorders, platelet number disorders, metabolic disorders (glutaric aciduria type 1)

  15. Retinal hemorrhages 85% cases Multilayered Extensive Bilateral

  16. Case 2 • 2 year old developmentally delayed tripped on rug and fell onto left side; cried right away, been grabbing ear since

  17. What bruises are suspicious? Accidental = peripheral Non-accidental = central

  18. Bite marks

  19. Slap marks

  20. Hemophilia

  21. Cord injury Erythema nodosum

  22. Vasculitis: Henoch-Schonlein Purpura

  23. Coining

  24. Cupping

  25. Case 3 Mom was running bath – 2.5 year old girl stepped into it when mom left to grab the phone

  26. Burns

  27. Staph scalded skin syndrome

  28. Burn patterns Accidental Non-accidental

  29. Burn from diarrhea

  30. Cigarette burns Healing impetigo Cigarette burns

  31. Curling iron

  32. Case 4 • 12 month old girl on shoulders of dad going down stairs when she lost balance and fell to the side and now not moving arm, swollen

  33. Long bone fractures D A C B

  34. Metaphyseal “Corner chip” fractures

  35. “Bucket handle” fracture

  36. Rib fractures

  37. Fractures from abuse • Non ambulatory child with fracture • Fracture from fall from bed/crib/couch • Strongly suggestive of: • Ribs • Long bone metaphyses • Scapula • Sternum • Vertebral spinous processes • Moderately suggestive: • Multiple fractures • Fractures of different ages • Epiphyseal separation • Vertebral body fractures

  38. Other signs of abuse • Traction alopecia • Growth parameters • Extensive dental caries • Severe diaperdermatitis • Neglected wound care

  39. Torn frenulum

  40. Other injuries Visceral abdominal • predominantly in children > 2 years old • 2nd most common cause fatalities • usually blunt trauma (punch or kick to abdomen, rapid deceleration after being thrown)

  41. Investigations • American Academy of Pediatrics/ Canadian Pediatric society guidelines • Skeletal survey: < 2yo • Consider repeat in 10 – 14 days • Head CT • Ophthalmology consult • CBC, coags • Bone scan? • Bone mineralization labs? Metabolic work up?

  42. What to do at the ACH Social work always available in the ED If concerned….. Call: • Child & Family Services: 297-2995 • Child abuse service: Dr. Neil Cooper • Sexual abuse clinic: Dr. Jen MacPherson (outpatient referrals)

  43. To admit or not to admit? • Medical need • Inability to guarantee safety

  44. Document document document HPI: Mother states “… was washing the dishes when I heard a thud and I ran to the living room and saw her on the floor”…. “she had rolled off the couch”…. P/E:

  45. It is an offence to fail to report suspected maltreatment

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