Child Maltreatment



Child Maltreatment


Anna D. Jarvis



Introduction



  • Child maltreatment is a complex syndrome that includes deliberate injury, inappropriate sexual contact, neglect, failure to provide the necessities of life, and/or emotional maltreatment of a child


  • Occurs in all segments of population, frequently undetected until a child dies


  • In US: ˜ 2.5% of all children are abused or neglected annually


  • Adult surveys: 20% of women and 5-10% of men report childhood sexual abuse


  • Must be alert to the possibility of child maltreatment at each clinical encounter


  • If suspect child abuse, required by law to report to Child Protection Services for investigation

Note: Child maltreatment is the current preferred descriptive terminology for child abuse


Types of Maltreatment



  • Physical: varies from harsh discipline to torture


  • Sexual


  • Neglect: 70% of failure to thrive in infancy is nonorganic


  • Emotional


Munchausen Syndrome



  • Deliberate injury of a child by poisoning, physical means, or interference with medical care so that the child presents sick or unwell or with “repeated life-threatening events”


  • Result is repeated and escalating medical investigation and intervention



Various Presentations



  • Unexplained electrolyte disturbances


  • Sepsis and unusual infecting organisms


  • Positive toxicology tests without history of ingestion


Vulnerable Child: Risk Factors



  • Premature


  • Colic


  • Physical/emotional challenges


  • Special needs


  • Demanding child


  • Delayed bowel/bladder control

Note: Only one child in a family may be victimized


Predicting Child Maltreatment



  • A very high proportion of children who experience abuse grow up to be abusers: the “cycle of abuse”


Social and Environmental Factors



  • History of childhood maltreatment in perpetrator


  • Alcohol/substance dependency


  • Crisis situation in perpetrator’s life


  • Spousal and domestic violence


  • Mental illness/depression in caregiver


Suspected Child Maltreatment



  • Consider possibility of maltreatment with all injuries


  • Explore exact mechanism and circumstance of injury


  • Ask, “Does the story make sense?” given the age and development of the child


  • Check past records for repeated or unusual injuries


  • Consider possibility of neglect or inappropriate supervision


  • Accident prevention information and teaching should be an integral part of acute injury care



Suspicious History



  • No history on mechanism of injury


  • Partial history


  • History changes


  • History is developmentally unrealistic


  • Delay in seeking care


  • Unrealistic expectations of child

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Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Child Maltreatment

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