HD 300 1st Edition Lecture7 Outline of Last Lecture I Spanking II Cultural differences in the Unites States III Is spanking violence IV Hitting Children v Hitting Wives V Myths about Spanking VI Short Term Effects VII Long Term Effects VIII Neurological Effects IX Corporal Punishment in Schools X Conclusions XI Alternatives to Spanking XII Shaken Baby Syndrome Outline of Current Lecture I Physical Abuse Defined II Overview a Physical abuse b Physical abuse continuum c Types of physical abuse III Catastrophic Abuse a CCM defined b Categories of CCM c Proposed legislation IV Response of the Medical Community a Background Information b The role of the physician c ER Protocols d Red Flags on Patient History e Red Flags on Exam f Injuries commonly seen in the ER g Typical Sites for abusive markings h Types of markings Current Lecture I Definition of physical abuse These notes represent a detailed interpretation of the professor s lecture GradeBuddy is best used as a supplement to your own notes not as a substitute a Physical act non accidentally inflicted by a person more powerful than the child b Consists of willful acts resulting in physical injury II Overview a Physical abuse i Classic example of child abuse ii Generally accepted as a clear form of maltreatment iii Most visible form of maltreatment b Physical Abuse continuum i Level of severity ranges from no abuse at all corporal punishment physical abuse catastrophic abuse and homicide ii Handout Physical Abuse Continuum III c Types of physical abuse i Spanking slapping whipping ii Beating iii Twisting arms legs ears nose etc iv Choking or smothering v Burning vi Throwing the child 1 On the floor down the stairs on the wall vii Biting viii Hair pulling 1 Traumatic alopecia ix Pinching x Cutting stabbing shooting xi Physically confining the child 1 Locking in closet 2 Chain to bed 3 Locking in car trunk xii Shaking Catastrophic Abuse a Catastrophic Child Maltreatment CCM defined i Purposeful acts inflicted on a child that are of the most severe nature ii These acts are so abhorrent no one would argue that they are in any way permissible behaviors iii These acts are so brutal that there is a high probability that they will have long lasting permanent negative effects on the child b Categories of CCM i Attempted murder ii Torture iii Mutilation iv Violent rape v Enforced prostitution vi Denying necessities required for minimal development profound neglect 1 Like starving a child A book A Child Called It one child s courage to survive By Dave Pelzer c Proposed Legislation i Speedy assessment by DSHS 1 File with court within 24 hrs of investigation ii Speedy judicial review 1 Once in the court the judge needs to review 2 Disposition within 48 hrs iii fast tracking cases for clinical services 1 Within 48 hrs 2 Need to figure out what medical services the child needs and to enact quickly iv Automatic waiver of bureaucratic limitations on service delivery periods 1 Recognize that permanent clinical services will be required for the child v Waiver of the presumption of family reunification 1 The child should not be placed back in home 2 Speedy determination of placement that meets the child s best interest within 1 month Unit 7 Response of Medical Community I II Background information a 15 of children brought in for treatment have been treated previously for similar injuries b 77 of those receiving treatment are under the age of 15 mos c The role of the physician a Only needs to have reason to suspect that abuse has take place in order to report b If abuse is suspected or confirmed the physician can order protective custody for 72 hours and no family member can discharge the child III ER Protocols a Identifying presenting signs and symptoms b Obtain a medical history c Do preliminary exam d Preserve forensic specimens and maintain chain of custody e Provide a written record of the exam and treatment i If it s not in writing it did not happen f Promptly report g Provide follow up counseling and services IV Red Flags on Patient History a Magical injury i I have no idea how that happened b Avoidable injury c Repeated injury several injuries to the same injury d Delay in medical care e Parents under or overestimate injury f Child fits a profile for risk i Looks underweight poor dental care child looks withdrawn V Red Flags on Exam a Injury history mismatch b Suspicious injury i Location of injury c Multiple injuries d Injuries in various stages of healing e Different injury forms i Fracture or 2 lacerations traumatic alopecia f Overall poor care g Symptoms of poisoning h Failure to thrive i Unexplained physical findings VI Injuries Commonly Seen in ER a 1 head injuries i Scalp swelling or bruising ii Retinal hemorrhage iii Skull fractures iv Traumatic alopecia v Subdermal hematomas b Abdominal injuries i Lacerations c Fractures d Sudden infant death syndrome as reported by parents i Not actually SIDS but parental causes e Failure to thrive f Sexual injuries g Scraping scratching lacerations h Burns i Bruises of various sizes and age VII Typical sites for Abusive Injuries a Buttocks lower back b Back of legs c Genitals inner thighs d Cheeks e Ear lobes f The upper lip g Back of the hands h Neck VIII Types of Abusive Markings a Belt buckle b Belt strap c Looped cord d Stick whip e Fly swatter f Coat hanger g Board h Spatula i Burn Injuries i Light bulb ii Hot plate iii Curling iron iv Car cigarette lighter v Iron vi Knives vii Grid viii Cigarette ix Immersion IX C Henry Kempe National Center for the Prevention and Treatment of Child Abuse and Neglect Denver CO a Slides showing injuries on abused children