Child Abuse

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Child Abuse

• Jan Bazner - Chandler
• CPNP, CNS, MSN, RN

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Physical Signs of Child Abuse

• The jigsaw in the diagnosis of physical abuse.

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Method of examination

• Consent
• Description of child and his injuries
• Organize equipment / assessment
• Notes / documentation
• Complete history, full physical examination,
  growth, and developmental level.

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Method of examination

• Differential diagnosis
• Skin disorders
• Blood dyscrasia
• Fractures due to osteogenesis imperfecta,
  osteoporosis
• Failure to thrive due to disease process

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Characteristic of Abuse

• Repetitive pattern of injury
• Injuries not consistent with injury
• Presence of other signs of abuse
• Unusual behavior of parent
• Incidental discovery of injury

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Patterns of injury

• Bruising to young baby
• Multiple injuries following a moderate fall
• Severe head injuries in babies or toddlers
• Rib fractures subdural hematoma and retinal
  hemorrhage
• Multiple cigarette burns
• Fractures in infant and toddler

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History of Falling off Bed
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Sub-conjunctival hemorrhage and bruising
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Fell down stairs
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Abnormal bruising patterns
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Abnormal Bruising Patterns
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Abdominal Trauma
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Human Bites
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Mouth Trauma
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Eye Trauma
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Scald Burns
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Neglect
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Sexual Abuse

• Genital injuries in boys
• Bruising to the penis and scrotum, petechiae and
  swelling
• Torn frenulum of penis
• A red circumferential mark due to a ligature
• Burn or scald
• Bites
• Damage to the urethral meatus

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Injuries to male genitalia
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Sexual Abuse in Girls

• Tears in hymen
• Thinning and destruction of hymen
• Enlarged hymenal opening
• Bleeding
• Labial fusion
• Dilated urethral opening
• Foreign body

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Injuries to female genitalia
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Types of Child Abuse

• Physical
• Sexual
• Neglect
• Emotional or Psychological abuse

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Physical Abuse

• An injury intentionally inflicted on a child by a
  caregiver, paramour of a parent, or anyone
  residing in the childs home.

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Sexual Abuse

• The use of a child for sexual gratification or
  financial gain, by an adult,older child, or
  adolescent, whether by physical force, coercion,
  or persuasion.

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Neglect

• Acts or omissions by the perpetrator that fail to
  meet the childs needs for basic living,
  including food, hygiene, medical care, clothing,
  and a safe warm environment.

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Emotional or psychological abuse

• Verbal abuse or excessive demands on the child
  that result I impaired growth, negative
  self-image, and disturbed child behavior.