13 - child abuse

What is the definition of child abuse?

any act OR failure to act as a parent/caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation

an act OR failure to act which presents an imminent risk or serious harm

Who is considered a child when talking about child abuse?

any person younger than 18 who is not emancipated

in Ohio, this includes people under 21 who have developmental or physical disability

what is physical abuse?

non-accidental physical injury inflicted by a parent, caregiver or other person who has responsibility for the child

considered abuse regardless of whether caregiver intended to hurt child

what is emotional abuse?

pattern of behavior that impairs child's emotional development or sense of self-worth

difficult to prove

what is sexual abuse?

the employment, use, persuasion, inducement, enticement or coercion of any child to engage in any sexually explicit conduct or simulation of such conduct, or the rape, molestation, prostitution or other form of sexual exploitation of children, or incest with children

what are examples of substance abuse?

1. prenatal exposure to drugs/alcohol

2. drug manufacturing in presence of child

3. selling/distributing/giving drugs/alcohol to child

4. use of controlled substances by caregiver that impairs ability to care for child

what is physical neglect?

1. failure to provide necessary food or shelter

2. lack of appropriate supervision

What is medical neglect?

failure to provide necessary medical or mental health tx → eyeglasses and hearing aids

what is an exception for medical neglect?

parents who choose not to seek medical care for their children d/t religious beliefs

what is educational neglect?

failure to educate a child or attend to their special education needs

what is emotional neglect?

failure to attend to a child's emotional needs or to provide psychological care

How many children suffer from child abuse or neglect?

1 in 10

How many children suffer from sexual abuse?

1 in 16

How many children are witness to family violence?

1 in 10

what gender is majority seen with victims of child abuse?

51% female

49% male

What age is majority seen with victims of child abuse?

75% are younger than 4 years old

50% younger than 1 years old

what race/ethnicity is majority seen with victims and perpetrators of child abuse?

African American, Native American, multiple race → 15-20/1000

White, Hispanic rate → 11/1000

Asian rate → 3/1000

what gender is majority seen with perpetrator of child abuse?

58% female

what parental (household) status majority is seen in child abuse?

both parent household → 40%

single parent household → 27%

what relationship to child majority is seen in child abuse?

parent → 83%

mom → 40%

both → 18%

non-parent → 10%

what age are most perpetrators to child abuse?

40% younger than 30 yrs

what is the prevalence of death due to abuse?

22%

what is the prevalence of death due to neglect?

33%

what is the majority relationship of perpetrators of death to victims?

parents 76%

father → physical

mother → neglect

what is the demographic of perpetrators of death?

mid-20s

little education

poverty

depressed

unable to cope with stress

abuse victim

who are the majority of reporters of physical abuse?

75% of professionals

what are the signs of neglect for a child?

1. freq absent from school

2. begs or steals food or money

3. lacks needed med or dental care, immunizations or GL

4. dirty and has severe BO

5. lacks sufficient clothing for weather

6. abuses alcohol or drugs

7. states there is no one at home

what are the signs of neglect for a parent?

1. appears to be indifferent, apathetic or depressed

2. irrational behavior or bizarre

3. abusing alcohol or drugs

what are the signs of abuse for a child?

1. sudden changes in behavior or school performance

2. no attention to physical or med problems

3. learning problems

4. watchful

5. lacks adult supervision

6. overly compliant, passive or withdrawn

7. does not want to go home

8. discloses maltreatment

what are the signs of abuse for a parent?

1. denies existence of or blames child for problems

2. ask for harsh physical discipline

3. sees child as bad

4. demands high level of physical or academic performance

5. shows little concern for child

what are the signs of physical abuse for a child?

1. unexplained burns, bites, bruises, broken bones, bizarre marks or black eyes

2. fading bruises

3. seems frightened of parents

4. abuses animals or pets

what are the signs of physical abuse for a parent?

1. offers conflicting, unconvincing or no explanation for child's injury

2. describes child negatively

3. uses harsh physical discipline

what are common physical abuse injuries?

1. bruises

2. bizarre marks

3. burns

4. ocular

where are the common locations for bruises?

1. buttocks

2. inner thigh/genitals

3. cheek

4. upper lip

5. neck

6. soft tissue areas

what is an indication that the bruising is from physical abuse?

multiple stages of bruising present → progression (tender, swollen, red, blue, green, yellow)

what are common causes of bizarre marks?

1. cord

2. belt

3. gag

what are common causes of burns?

1. cigarette

2. branding

3. immersion/scalding

what are the ocular signs of physical abuse?

1. black eyes

2. subconj hemes

3. retinal hemes

involvement of BOTH eyes

what ocular sign is pathognomonic for abuse?

retinal hemes

children younger than 2 yrs → 60% abused had retinal hemes, 40% bilateral

what are the signs of sexual abuse in a child?

1. difficulty walking or sitting

2. refuses to change for gym or participate in physical activities

3. reports nightmares or bedwetting

4. sudden change in appetite

5. bizarre, unusual sexual knowledge or behavior

6. attaches quickly to strangers or new adults

what are the signs of sexual abuse in a parent?

1. protective of child or limits child's contact

2. secretive and isolated

3. jealous or controlling of family members

what are the long term consequences of abuse?

1. development of psychological disorder

2. drug abuse

3. prison, criminal activity

what is the direct cost of child maltreatment and related fatalities in 1 yr in US?

$124 billion

what are the indirect costs of child abuse?

long term economic consequences to society → health-care, criminal activity, mental illness, substance abuse, domestic violence

how much money does child abuse and neglect prevention save?

$104 billion each year

do you have to report if you suspect abuse?

health care professionals have legal obligation to report suspected abuse/neglect

can you get in trouble for reporting abuse?

immune from civil or criminal liability if acting in good faith

what is the clinic procedure for reporting suspected abuse?

consult with clinical attending → interns do not report directly

document reasons for suspicion and actions taken in clinic record

attending to notify associate dean

who does the suspected abuse get reported to?

1. children's services

2. franklin country sheriff

3. CPD

when reporting suspected abuse, what do you provide?

1. child name, address, age

2. parent or caretaker name and address

3. name of person suspected of abuse/neglect

4. reason for suspicion