Child Abuse – Recognizing and Managing on the USMLE Step 2 CK

by / Tuesday, 29 June 2010 / Published in Pediatrics

Child Abuse

  • Suspected child abuse requires your BY LAW to report the suspected abuse.
  • You must also explain to the parents why you suspect abuse and that you are legally obligated to report it to child protective services.
  • If a parent refuses hospitalization or treatment of their child against the best interest of the child, you must get an emergency court order.

High-risk children:

  • Premature infants
  • Children with chronic medical problems
  • Infants with colic
  • Children with behavioral problems
  • Poverty stricken children
  • Children of teenage parents
  • Single parents
  • Children of substance abusers

Classic findings:

  • Chip fractures (damage to the corner of metaphysis in long bones)
  • Spiral fractures
  • Rib fractures
  • Burns (immersion in hot water, cigarette burns, stocking-glove burns on hands and feet)
  • Head injury – MCC of death
  • Sexual abuse

When to hospitalize a child under suspect of being abused:

  • The hospital is the safest place for the child
  • The diagnosis is still unclear
  • The child has a medical condition requiring hospitalization

Workup for suspected child abuse:

  • PT/PTT/BT
  • Full skeletal survey for breaks
  • If injuries are severe, get a CT or MRI + a thorough eye exam
  • If injury is to the abdomen, get an abdominal CT, check for blood in the stool and urine, and check liver and pancreatic enzymes

Treatment:

1st – Address medical and/or surgical issues before all else

2nd – Report abuse to child protective services (CPS)

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