Child Abuse

Child abuse

Definition Types 7 When to suspect? 5 Who should take history? Symptoms pattern? Skeletal DD? Investigations? Multi sectoral management? How to admit? Levels of inteference? Different sectors involved? Procedure to be followed in paed ward? Who takes history from the victim? CCC? ICC? Particpation and roles? 3+ 14 Age of consent and marriage? Children under 14 years? Only for 3 ? 16 yrs?

ice-berg phenomenon

"non-accidental injury" - most common abuse, euphemism of physical child abuse - physical, chemical

neglect - common when active abuse is restrained (esp in west). sexual abuse (can be diagnosed) with family members in community -

(for physical and chemical abuse)

history should be preferentially taken from SR or consultant to prevent development -

for diagnosis can consult judicial medical officer

children - whole body skeletal survey - multiple green stick fractures at different stages of healing to the exclusion of other radiological features of osteogenesis imperfecta (brittle bone diseases)

shaken baby syndrome - SDH + retinal haemorrhages

cigarette burn

sexual abuse - assumed menarche or bleeding per rectum from trauma and bleeding

reflex anal dilatation - suggests but doesn't diagnose sexual abuse

somatisation due to stress or abuse

sudden onset unusual behaviours - eg sexualized behaviour

(inappropriate to sit on laps coz sexual stimulation to child or person)

children with sexually inappropriate behaviour - masturbation not necessarily

FORENSIC INVESTIGATIONS

Multidisciplinary so must ADMIT to make or break the diagnosis (false pretext or by care order by magistrate to transfer power of care from parents to social workers)

reduce re-traumatization - coz of stigma and mental

reintegrate to same families or foster homes

holistic - physical, emotional, social, psychological

sometimes legal not taken when it is against the interests - decision taken by police AND team