[01.21c] PED - Child Abuse and Protection Topics (Part 3) V2.pdf

Recognition

What is the first and most critical step in child protection?

Identifying patterns

How do clinicians recognize child abuse, which is the same method used to recognize disease?

History, physical examination, developmental context, and risk factors

Recognition of child abuse relies on what four things?

Continued risk for repeat injury

What is the consequence of missed recognition of child abuse early on?

Inconsistent, vague, or evolving

A history should prompt suspicion of abuse if it is described in what three ways?

Unexplained or implausible

What two words describe an injury that should enter the differential diagnosis for abuse?

Concerning caregiver behavior or family context

Besides history and injury type, what other non-clinical factor should prompt concern?

Recognizing situations that require close evaluation

Recognition is not about clinical certainty, but about what?

Changing or conflicting stories

What is a historical red flag regarding the narrative of the injury?

Inconsistent with injury severity

An explanation for an injury is a red flag if it is what?

Another child

Suspicion should be raised if an injury is attributed to whom?

Found injury or no history provided

What is a concerning red flag regarding the origin of an injury?

Verbatim

How should important statements from different caregivers be documented?

Developmental assessment

What is considered a powerful recognition tool to check if an injury matches motor milestones?

Those who dont cruise rarely bruise

What is the key principle regarding bruising in infants?

Non-mobile infants

Which group of children rarely sustains accidental bruises?

Presence and absence

A complete head-to-toe assessment must document both the what and what of findings?

Young pre-ambulatory infant

ANY injury to which specific group of children is a physical examination red flag?

Multiple organ systems

Abuse should be suspected if injuries involve what?

Different stages of healing

Multiple injuries are concerning if they are in what state?

Non-bony or unusual locations

Where are abusive injuries typically located compared to accidental play trauma?

Patterned injuries

What type of injuries reflect contact with a specific object?

Stocking- or glove-like

What specific patterns describe forced positioning burns?

Bilateral or mirror-image

What type of injuries are uncommon in accidents?

Sentinel injuries

What are minor but unexplained injuries in infants that serve as early warning signs of severe abuse?

Abusive head trauma

What is a leading cause of morbidity and mortality in physically abused infants?

Unexplained neurologic symptom

What symptom in a baby should prompt concern even if the history does not explain the severity?

Seizures or altered mental status

What are two specific neurologic signs in infants that might indicate abusive head trauma?

Apnea or unexplained vomiting

What are two non-neurologic signs in infants that suggest head injury?

Rapid head growth and retinal hemorrhages

What are two physical findings in an infant's head or eyes that suggest abuse?

Minimal or absent external trauma

Abusive head trauma should be considered even in cases with what?

Disclosure

What is the most important clue for recognizing sexual abuse?

Pregnancy in adolescents

What reproductive health finding is a recognition clue for abuse?

Sexually transmitted infections

What medical condition in a child is a clue for sexual abuse?

Sexualized behavior inappropriate for age

What behavioral sign is a recognition clue for sexual abuse?

Psychosomatic complaints or suicidality

What two behavioral or psychological signs are listed as clues for abuse?

Normal PE

What type of physical exam does not exclude the possibility of sexual abuse?

They leave fewer visible signs

Why are emotional abuse and neglect frequently overlooked?

Withdrawal, fearfulness, or low self-esteem

What are three psychological signs of emotional abuse?

Failure to thrive or developmental delay

What are two physical or growth-related signs of neglect?

Chronic unmet medical needs

What is a sign of medical neglect?

Exposure to domestic violence

What specific household environment is recognized as a form of psychological harm and maltreatment?

Young age

Which child factor puts them at the highest risk for severe injury?

Disability or chronic illness

Besides age, what other child factor increases vulnerability?

Substance use and mental health concerns

What are two caregiver factors that increase risk?

Prior child protection involvement

What history-based family factor is a risk context?

Heighten clinical vigilance

Risk factors do not diagnose abuse, but they do what?

Accumulation of red flags

Recognition requires a pattern over time and what else?

Sexual abuse

A 3 year old girl with gonorrhea and foul-smelling vaginal discharge is an example of what?

Gonorrhea

Which infection is a definitive finding for sexual abuse in a 3 year old because it cannot be passed during birth?

Large age difference and pregnancy

What were the two bases for identifying Case 2 as sexual abuse?

No consent

What is the legal status of consent between a child and an adult in a relationship?

16

According to RA 11648, what is the current age of sexual consent in the Philippines?

Not more than 3 years

To be a non-abusive relationship, the age gap between a minor and an older person must be what?

12

What was the previous age of sexual consent?

Neglect

A mother failing to supervise her 12 year old daughter who then gets pregnant can be an example of what?

Grooming

What process might be involved if an adult leverages a child's emotional needs or lack of family care?

Physical abuse

Strangulation marks on the neck of a 10 month old are an example of what?

Injury appearance does not match reported mechanism

Why was the towel rubbing explanation in Case 3 rejected?

Neglect

Allowing children to ride on a motorcycle as shown in the source is an example of what?

Provide supervision

Neglect in Case 4 is based on the parents' failure to do what?

Not abuse

If a neighbor calls a child names and takes a picture once, why is it technically not emotional abuse according to the source definition?

Repeated patterns of damaging interactions between a caregiver and child

What is the definition of emotional or psychological abuse?

Yaya or caretaker

In the example of a child being locked in a cabinet, why is it abuse?

Polyvictimization

A 15 year old girl hit by her father and publicly slapped or insulted is an example of what?

Physical and emotional abuse

What are the two types of abuse in polyvictimization?

MNDM

What were the initials of the 1 year 2 month old male referred for physical abuse?

Head and genitals

The health center physician saw suspicious injuries on what two areas of MNDM?

Detailed history, thorough physical exam, forensic tests, photo documentation, and referral

What are the five components of a medical evaluation for an abused child?

Childs account of what was experienced

What should be recorded whenever possible during the medical evaluation?

Extragenital and anogenital examination

What two types of exams are done to diagnose acute and chronic injuries?

Reassure the child and parent

What should a physician do after the exam regarding the child's "OK" status?

Immediate and ongoing safety

The medical evaluation aims to evaluate what specific patient needs?

Expert witness testimony

Physicians may be required to provide what in legal proceedings?

Medical stability

What must be established before beginning the full medical evaluation?

Bleeding, poisoning, airway compromise, or pain from fracture

What are four signs of medical instability?

Child-friendly and welcoming

How should the setting of the evaluation be described?

Active listening and honest answers

What two things help build rapport with the child?

Same routine clinical principles

Interviewing and examining a suspected abuse follows what principles?

Medicolegal examination

A medical examination becomes what if you correlate injuries with development and biomechanics?

Acute examination

An examination within 72 hours of the most recent incident is called?

Non-acute examination

An examination after 72 hours of the most recent incident is called?

Parent or guardian

From whom must consent be obtained before an evaluation?

Assent

Depending on the child's age, what should be obtained from the child alongside consent?

DSWD or local social welfare worker

Who can authorize an examination if the parent is the suspected perpetrator or is absent?

Minimize repeated interviews

What is one way to avoid retraumatizing the child?

Developmentally appropriate, non-leading, non-suggestive, and non-traumatic

History taking should be performed in what four ways?

Child development, sexual abuse victimization, biomechanics, and effects of abuse

Physicians must be knowledgeable in what four areas to get a good history?

Who, What, When, and How

What four questions should be asked regarding historical data?

Why

What specific type of question should you NOT ask a child (e.g., Bakit di ka nanlaban?)

HEADSSSS

What assessment tool is used for psychosocial history in teens?

Separately

How should the guardian and the child be interviewed whenever possible?

Quotation marks

How should verbatim statements be indicated in the records?

Introduce self as doctor and helping person

What is the first step when starting the child's interview?

Say I dont know or correct the interviewer

What two permissions should be given to the child as ground rules?

Concepts of numbers or time

What do young children often lack, making interpretation of their answers sensitive?

Terminology

What might children use differently than adults when answering questions?

Open-ended questions

What type of questions should always be used first?

Leading questions

What type of questions should be avoided?

First and last occurrence

If there were multiple incidents, what are the most important timings to determine?