Maltreatment in Children

1. Describe most common signs of abuse, neglect or maltreatment in children 2. Identify resources and requirements for reporting

when to report

“To know or have reason to believe a child is being neglected or physically or sexually abused.

Why to report 

failure to report is a misdemeanor 

How to report

within 24 h oral and 72 h written

When to call law enforcement

when its an emergency

When to call CPS

When immediate safety is not a concern but maltreatment is suspected

“Screened Out”

• high rate

• CPS not opening an investigation because of lack of evidence 

• Not primary invention 

protective hold

• Parents are the primary decision-makers.

• law enforcement decides visitation

• nurse is the neutral person

Signs of abuse

• changing hx

• patterned brusing 

• atypical for infants: faces, ears, genitalia, or buttocks 

head trauma

• leading cause of serious head injury 

• 2/3 of perpetrators are male

head trauma higher incidence in:

• Premature infants

• Twins

• Children with moms < 18 years of age

• Children in military families

sexual abuse

• affects both sexes equally 

• Girls have a higher rate of abuses as adolescents. 

• Most exams are “normal”

• STIs in children >3<10 suspicious 

Pre-pub physical forensic exam

• Test for STIs, do NOT treat empirically

• Never do speculum exam

• Evidence collection window up to 24 hours

Prost-pub physical forensic exam

• Consider testing for STIs, often treat empirically

• May require speculum exam

• Evidence collection window up to 72 hours

Prevention of Sexual Abuse (SA)

• Kids should be taught what is ok

• Teach names for body parts

• Anatomically correct if possible

• Talk about secrets

• Talk about what to do if Sexual Abuse happens

• OK to ask if SA has happened

• Avoid grilling

Neglect

Defined as failure of a caregiver to:

◦ Provide needed food, clothing, shelter, medical or mental health care, education or appropriate supervision

◦ Protect a child from conditions or actions that endanger the child

◦ Take steps to ensure that a child is educated as required by law

At what age can you never leave a child alone in Minnesota

<7 years