1
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- Physical, Sexual, Emotional, and Neglect
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2
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- Unexplained bruises and welts
- on face, lips, or mouth
- on torso, back, buttocks, or thighs
- pattern/clusters
- In various stages of healing
- shaped like recognizable object (like a belt buckle)
- appear regularly after child is at home
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3
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- Unexplained burns
- by cigars, cigarettes, especially on soles, palms, back, or buttocks
- Immersion in hot liquid
- recognizable form like range coils
- by rope on arms, legs, neck, or torso
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4
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- Unexplained fractures of skull, nose, or facial bones
- in various stages of healing
- in multiple locations
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5
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- Unexplained lacerations or abrasions
- on mouth, lips, gums, or eyes
- on external genitalia
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6
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- Wary of adult contacts
- Apprehensive when OTHER children cry
- Extreme aggressiveness or extreme withdrawal
- Fear of parents/fear of going home
- Reports of injury by parents
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7
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- Begging or stealing food
- Early arrivals and late departures
- Constant fatigue or listlessness
- Chronic delinquency, especially thefts
- Reporting of no caretaker at home
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8
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- Begging or stealing food
- Early arrivals and late departures
- Constant fatigue or listlessness
- Chronic delinquency, especially thefts
- Reporting of no caretaker at home
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9
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- Each of the 50 states has a mandatory reporting for person such as
teachers who may suspect abuse
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10
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- Any non-accidental injury inflicted by a caretaker
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11
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12
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- Infants and young children
- Mental or physical disabilities
- The “challenging” child
- Dysfunctional or isolated families
- Substance abuse in the home
- Unrealistic parental expectations
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13
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- Lack of concern for child’s injuries/pain
- Inability/unwillingness to comfort child
- Delay in seeking needed medical care
- Incompatible or absent history
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14
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- Abuse
- on padded areas
- pattern injuries
- many lesions
- Accidental
- on poorly padded areas
- non-specific patterns
- few lesions
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15
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- Bleeding disorders
- Mongolian spots
- Henoch-Schonlein Purpura
- Coin rubbing, cupping
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16
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- rib
- metaphyseal (corner or bucket handle)
- acromion
- spinous process
- sternum
- hands and feet
- vertebral body fractures & subluxations
- complex skull fractures
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17
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18
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- multiple fractures
- fractures of different ages
- fracture not adequately explained
- occult fracture
- fracture in an infant
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19
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- Abused children: young and multiple fractures
- 55%-70% of fractures occur before age 1 year
- > 50% have multiple fractures
- Non-abused children: older with fewer fractures
- >98% of fractures seen after 18 months of age
- multiple fractures are uncommon
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20
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- Osteogenesis imperfecta
1/50,000 live births have
OI Type IV
- Child abuse
1/1000 abused children
have fractures
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21
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- Burns
- Blunt abdominal trauma
- Liver, spleen, pancreas, bowel
- Shaken Baby Syndrome (Head injury)
- Intra-cranial injury
- retinal hemorrhage (80%)
- Absent is external signs of trauma
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22
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- Consider SBS in infants with:
- intracranial injury after minor trauma
- scan infants with symptoms indicative of head injury
- retinal hemorrhages
- Does the history explain the injuries?
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23
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24
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- These injuries were probably not caused by the events that you are
describing.
- I’m concerned that someone may be harming your child. Do you have any of these same
concerns?
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25
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- Juvenile system Protects the child
- child protective services
- juvenile court
- Criminal justice system Prosecutes crimes
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26
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- Recognition of suspicious injuries
- Assist or perform physical evaluation
- obtain supporting evidence
- find alternative diagnosis
- Report suspected abuse
- Remain objective
- Advocate for the child
- 1-800-96-ABUSE
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