Snapshot A 3-year-old girl is brought to the dermatology office for a purpuric rash, referred by her pediatrician. She has no significant past medical history and no family history of bleeding disorders. On physical exam, she is noted to have right-sided ecchymotic patch on her right helix and ecchymosis scattered on her buttocks. The patient is shy and avoids eye contact. Suspicious, the dermatologist discusses her findings with the pediatrician, and a report to Child Protective Services (CPS) is filed for further investigation. (Child abuse) Introduction Introduction there are many forms of child maltreatment, including child neglect, child abuse, and infant deprivation child abuse or neglect accounts for up to 13% of deaths in children < 15 years of age 40% of deaths related to child abuse or neglect happen in those less than 1 years of age any suspected child maltreatment should be reported to CPS Infant Deprivation Infant deprivation of affection, if longer than 6 months, can lead to permanent damage to the patient’s mental and emotional development Presentation failure to thrive and weight loss decreased muscle tone poor language skills poor socialization skills disinhibited social engagement infant attaches to strangers reactive attachment disorder infant is unresponsive to comforting lack of basic trust Complications infant death in severe cases Child Neglect Child neglect is the most common type of child maltreatment and may be difficult to diagnose failure to provide a child with basic needs food shelter supervision education affection Presentation poor hygiene poor social skills poor emotional development failure to thrive weight loss and malnutrition Complications nutritional deficiencies Child Abuse Child abuse is a form of child maltreatment that results in injury and can be physical or medical (factitious disorder imposed on another) Presentation physical abuse bruising in pre-mobile infant numerous bruising in a crawling child “red flag” areas include torso, ears, neck, or buttocks bruises in the shape of an object (i.e., belt marks) human bite marks unexplained major traumas fractures ribs or long bone spiral multiple bone fractures in different stages of healing burns cigarette burns, particularly on buttocks/thighs subdural hematoma retinal hemorrhages inconsistent history a pre-mobile infant rolling out of bed delayed medical care changes within the caregiver history typically perpetrated by patient’s female primary caregiver sexual abuse genital, anal, or oral trauma recurrent urinary tract infections sexually transmitted infections patient simulation of intercourse or foreplay typically perpetrated by a male adult known to the victim Studies skeletal survey to assess for bone fractures Complications death
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.PY.15.27) A 9-year-old girl is brought to the pediatrician by her father for dysuria, genital pruritus, and vaginal discharge. Cultures of the discharge are sent, revealing the causative agent to be a Gram-negative glucose-fermenting, non-maltose fermenting diplococci. Which of the following steps should the physician follow next? Tested Concept QID: 107046 Type & Select Correct Answer 1 Tell the father that the child needs antiobiotics to treat the bacterial infection 4% (4/91) 2 Discuss with the father that the child is being sexually abused 2% (2/91) 3 Contact the mother instead of the father 0% (0/91) 4 Contact Child Protective Services 87% (79/91) 5 Treat the child with antibiotics and schedule a follow up 3% (3/91) M 3 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.PY.12.1) You are asked to examine a 1-year-old child brought to the emergency department by his sister. The sister reports that the child has been acting strangely since that morning after "getting in trouble" for crying. The child appears lethargic and confused and is noted to have a cigarette burn on his forearm. Emergency head CT reveals a subdural hematoma. Which of the following additional findings is most likely? Tested Concept QID: 101938 Type & Select Correct Answer 1 Posterior rib fracture 5% (9/171) 2 Bilateral retinal hemorrhages 71% (122/171) 3 Skull fracture 15% (26/171) 4 Burns to buttocks 5% (9/171) 5 Epidural hematoma 1% (2/171) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept