Child Abuse - Non accidental injury and child abuse- Paediatrics

Child abuse - Paediatrics - undergraduate presentation.

1. Non accidental Injury & child Abuse G1E

2. Definition Salah Omer

3. Child abuse, also known as non-accidental trauma or maltreatment, was first described by Tardieu in 1860. But today the definition of exactly what constitutes child abuse is highly variable because there is no universally agreed definition. It can range from severe physical or sexual abuse to subtle neglect or emotional abuse. Part of the difficulty defining child abuse is because the line between punishment and abuse is very subjective to different parents, communities, legal systems.

4. The World Health Organization (WHO) defines child abuse as “ all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity. In high-income countries it is estimated that 4-16% of children are physically abused annually. It is the third leading cause of death in children between one and four years of age .

5. Risk Factors By: Safia Murtada

6. There are some factors that Increase the Risk to children and make them more vulnerable to abuse These factors can be Found in : The background of parents The environmental situation The attributes of the child themselves

7. Parental factors Parent has already abused a child Pregnancy was not wanted Parent has a background of abuse growing up Young, unsupported mother often with low education Parent is isolated and has few supports Parent has a mental illness or is abusing drugs or alcohol

8. Environmental factors Overcrowding in the house Poverty or lack of opportunity to improve the family’s resources Family violence is present A non biological adult living in the house Family is experiencing multiple stresses

9. Child factors Baby is sickly, colicky, or unwanted Child has a physical or developmental disability Child is the product of an abusive relationship Lack of attachment between child and parent

10. Malaz siddeg younis

11. Common signs and symptoms soft tissue injury Thermal injury Skeletal injury Internal injuries Fabricated injuries ( Munchausen syndrome)

12. Soft tissue injury bruising Bite marks Periorbital injury Intraoral Abrasions lacerations

13. Thermal injuries Scalds Contact burns Fire burns Cigarette burns Electrical burns Friction burns Chemical burns

14. Skeletal injuries Epiphyseal separations Humurs or femur Digital Skull

15. Internal injuries Brain injury Retinal haemorrhage Abdominal injuries

16. Sexual abuse Sudden awareness of genitals Sexual acts Sexual words Attempt to get other children in performing sexual acts

17. thankyouuuu Elhadi was a case of child abuse and will talk about it

18. Classification Heba Saeed

19. Classification of non accidental child injury Children abuse is divided into six classes. 1.Physical abuse. 2.Sexual abuse. 3.Emotional abuse. 4.Neglect. 5. Abuse in a medical setting 6. Cultural factors

20. PHYSICAL ABUSE Injuries in the skin - important sign of physical abuse, Skin signs are frequently accompanied by other forms of physical injury (e.g. fractures).

21. Signs and symptoms Binding injuries Wrists and ankles are tied. Acute injuries may present with soft-tissue swelling, redness, warmth or abrasions around the wrists and ankles. Bruises Physical abuse is frequently identified by bruising, which may be multiple and in different stages of healing .

22. Thermal burns Cigarette burns can often be suspected where there are one or more rounded ulcers or erosions.

23. Head and eye injuries Intracranial injury with no major confirmed accidental trauma or medical cause. Retinal haemorrhages, rib or long bone fractures w/ or multiple subdural haemorrhages.

24. SEXUAL ABUSE Adult or older adolescent uses child for sexual stimulation, asking or pressing a child to engage in sexual activities & using children to produce child pornography . Sexual touching of any part of the body, clothed or unclothed; Penetrative sex Molestation (genital contact without intercourse) Encouraging a child to engage in sexual activity; Intentionally engaging in sexual activity in front of a child; (or showing material) exposure of the perpetrator's genitals

25. Signs and symptoms Sudden awareness of genitals and sexual acts and words. Attempting to get other children to perform sexual acts. Drawings that show sexual acts. Unexplained fear of known adult, example uncle brother or any relative. Emotional or behavioural changes, example depression, self-harm, low self-esteem. Running away from home. Eating disorders. Insecurity. Pregnancy in girl below 18 years.

26. Genital signs and symptoms Dysuria, soreness, itching, bleeding or discharge from genitals or anus--recurrent or persistent and not explained by medical condition e.g UTI , worms, skin condition. Gaping anus observed during an examination without a medical explanation e.g neurological disorder or severe constipation. Genital or anal injury without suitable explanation Sexual transmitted infections including genital warts, hepatitis B without clear evidence of vertical transmission.

27. EMOTIONAL ABUSE This is a mental distortion of a child’s mind. Emotional abuse is inflicting emotional harm through the use of words or actions. E.g yelling, threatening, corrupting Symptoms & Signs Delayed development Low self-esteem, self-blame, over-reaction to mistakes. Carers repeatedly humiliate the child.

28. Abuse in a medical setting   Factitious Disorder Imposed on Another )  Caregivers intentionally produce physical/psychological symptoms or signs in a child. Caregivers may injure the child with drugs or other agents or add blood or bacterial contaminants to urine specimens to simulate disease. Many children receive unnecessary and harmful or potentially harmful tests and treatments.

29. NEGLECT -Very common type of child abuse -Pattern of failing to provide for a child's basic physical , emotional, educational, and medical needs Signs and symptoms Malnutrition. Excessive crying, tiredness and hunger. Poor hygiene and clothing. Frequent school absence. Untreated medical problems and failure to attend important child health programmes

30. Cultural factors Severe corporal punishment ( e.g , whipping, burning, scalding) Likewise, certain cultural practices ( eg , female genital mutilation) are so extreme as to constitute abuse. Certain folk remedies ( e.g , coining, cupping, irritant poultices) often create lesions ( e.g , bruises, petechiae , minor burns Anti-vaccine movement

31. diagnosis Mohamed khalid

32. How do you diagnose? History Examination

33. History False history. Injuries that do not fit with the developmental age of the child. Children known to social services, particularly if parental/ carer risk factors are also present. Faltering growth. Poor parent-child bonding . Parental attempts at excusing or justifying the injury inappropriately

34. Examination Injuries that are inconsistent with history. Blunt instrument marks or burns. Human hand marks or bite marks. Multiple injuries at different stages of healing. Evidence of poor care or failure to thrive.

35. General presentation Bruises Burns Fractures Abusive head trauma

36. Bruises Most common manifestation of abuse. Unusual sites include (buttocks, trunk, genitals, ears, back of hands) They reflect the instrument used

37. Burns 15-25% of burns are due to abuse. They also reflect the instrument used.

38. Fractures 2 nd most common manifestation of abuse. 85% in children under age of 3, and 69% in infants under age of 1 Bucket handle fracture. Spiral fractures. Femur fracture prior to walking age. Bilateral long bone fractures. Anterior or posterior rib fracture. Fractures in sternum and scapula. Skull fractures. Multiple fractures.

39. Abusive head trauma Known as shaken baby syndrome. Most common cause of child abuse death. Result in: subdural hemorrhages, diffuse retinal hemorrhages, diffuse brain injury. Retinal hemorrhages 60-85% of non accidental injury.

40. Differential diagnosis Bruises: Mongolian spots, hemangioma, bleeding disorders, malignancy, folk healing. Fractures: congenital syphilis, rickets, OI (osteogenesis imperfecta) Burns: hypersensitivity, photodermatitis , folk healing. Abusive head trauma: vasculitis, accidental trauma,

41. Management Ahmed Ehab

42. Child Abuse Child abuse can be detected from the second a patient is seen if it is very severe,especially if its physical abuse. Patients suspected of being abused should be investigated carefully for any signs of abuse that can not be noticed easily.

43. Medical management can range from inpatient care to outpatient treatment with close follow-up by a physician, a social worker, and Child Protective Services.

44. Admission If medical indications are present then admission would be a wise action. Indications: e.g. severe burns, head injury, requirement for serial examinations unsafe home environment, delayed outpatient Child Protective Services evaluation, and inpatient observation of child-parent interactions.

45. Find the root of abuse In order to manage abuse and reverse it you need to find what is causing it first. Unfortunately it’s the parents themselves sometimes. In those cases a multidisciplinary approach, or “child protection team,” is strongly encouraged to ensure adequate evaluation, treatment, and follow-up of a potentially abused child.

46. Follow up Following up with a patient who is susceptible to abuse or been abused before is very important in order to make sure that all your efforts don’t go to waste and that all the risk factors are ether stopped or decreased for the longest time possible.

47. Keep them safe The take home message should be that abuse can only be stopped if we all work against it. Starting from parents up to police officials. It should be seen as a great hazard in a childs life and a crime that should serious punishments.