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WSU HD 300 - Physical Abuse and Catastrophic Abuse
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HD_300 1st Edition Lecture7 Outline of Last Lecture I. SpankingII. Cultural differences in the Unites StatesIII. Is spanking violence?IV. Hitting Children v. Hitting WivesV. Myths about SpankingVI. Short Term EffectsVII. Long Term EffectsVIII. Neurological EffectsIX. Corporal Punishment in SchoolsX. ConclusionsXI. Alternatives to SpankingXII. Shaken Baby SyndromeOutline of Current Lecture I. Physical Abuse DefinedII. Overviewa. Physical abuseb. Physical abuse continuumc. Types of physical abuseIII. Catastrophic Abusea. CCM definedb. Categories of CCMc. Proposed legislationIV. Response of the Medical Community a. Background Informationb. The role of the physicianc. ER Protocolsd. “Red Flags” on Patient Historye. “Red Flags” on Examf. Injuries commonly seen in the ERg. Typical Sites for abusive markingsh. Types of markingsCurrent LectureI. Definition of physical abuseThese 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 childb. Consists of willful acts resulting in physical injuryII. Overviewa. Physical abuse:i. Classic example of child abuseii. Generally accepted as a clear form of maltreatmentiii. Most visible form of maltreatmentb. Physical Abuse continuumi. Level of severity ranges from no abuse at all, corporal punishment, physical abuse, catastrophic abuse, and homicideii. Handout: Physical Abuse Continuumc. Types of physical abusei. Spanking/slapping/whippingii. Beatingiii. Twisting (arms, legs, ears, nose, etc.)iv. Choking or smotheringv. Burning vi. Throwing the child1. On the floor, down the stairs, on the wallvii. Biting viii. Hair pulling 1. Traumatic alopeciaix. Pinchingx. Cutting, stabbing, shootingxi. Physically confining the child1. Locking in closet2. Chain to bed3. Locking in car trunkxii. Shaking III. Catastrophic Abusea. 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 waypermissible 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 CCMi. Attempted murderii. Tortureiii. Mutilationiv. 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 Pelzerc. Proposed Legislationi. Speedy assessment by DSHS1. File with court within 24 hrs of investigationii. Speedy judicial review1. Once in the court the judge needs to review 2. Disposition within 48 hrs iii. “fast-tracking” cases for clinical services1. Within 48 hrs.2. Need to figure out what medical services the child needs and to enact quicklyiv. Automatic waiver of bureaucratic limitations on service delivery periods1. Recognize that permanent clinical services will be required for the childv. Waiver of the presumption of family reunification1. The child should not be placed back in home 2. Speedy determination of placement that meets the child’s best interest within 1 monthUnit 7: Response of Medical CommunityI. Background informationa. 15% of children brought in for treatment have been treated previously for similarinjuriesb. 77% of those receiving treatment are under the age of 15 mos.c.II. 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 childIII. ER Protocolsa. Identifying presenting signs and symptomsb. Obtain a medical history c. Do preliminary examd. Preserve forensic specimens and maintain chain of custody e. Provide a written record of the exam and treatmenti. If it’s not in writing it did not happenf. Promptly reportg. Provide follow-up counseling and servicesIV. “Red Flags” on Patient History a. “Magical” injury i. I have no idea how that happened!b. Avoidable injuryc. Repeated injury: several injuries to the same injuryd. Delay in medical care e. Parents under or overestimate injury f. Child fits a profile for riski. Looks underweight, poor dental care, child looks withdrawnV. “Red Flags” on Exama. Injury/history mismatchb. Suspicious injuryi. Location of injuryc. Multiple injuriesd. Injuries in various stages of healinge. Different injury formsi. Fracture or 2, lacerations, traumatic alopeciaf. Overall poor careg. Symptoms of poisoning h. Failure to thrivei. Unexplained physical findingsVI. Injuries Commonly Seen in ERa. #1 head injuriesi. Scalp swelling or bruisingii. Retinal hemorrhageiii. Skull fracturesiv. Traumatic alopecia v. Subdermal hematomasb. Abdominal injuriesi. Lacerationsc. Fracturesd. Sudden infant death syndrome as reported by parentsi. Not actually SIDS but parental causese. Failure to thrivef. Sexual injuriesg. Scraping/scratching lacerationsh. Burnsi. Bruises of various sizes and age VII. Typical sites for Abusive Injuriesa. Buttocks, lower backb. Back of legs c. Genitals, inner thighsd. Cheekse. Ear lobesf. The upper lipg. Back of the handsh. Neck VIII. Types of Abusive Markingsa. Belt buckleb. Belt strapc. Looped cordd. Stick/whipe. Fly swatterf. Coat hangerg. Boardh. Spatula i. Burn Injuriesi. Light bulbii. Hot plateiii. Curling ironiv. Car cigarette lighterv. Ironvi. Knivesvii. Gridviii. Cigaretteix. ImmersionIX. C. Henry Kempe National Center for the Prevention and Treatment of Child Abuse and Neglect, Denver COa. Slides showing injuries on abused


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