ABP Child Abuse Pediatrics flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Sentinel injury

A minor injury in a pre-mobile infant or a bruise in an infant younger than 6 months that strongly predicts subsequent severe abuse and warrants evaluation.

TEN-4 bruising rule

Bruising to the torso, ears, or neck in a child younger than 4 years, or any bruise in an infant younger than 4 months, is suspicious for abuse.

Classic metaphyseal lesion

A corner fracture of the metaphysis in an infant, highly specific for inflicted injury, often seen at the distal femur, proximal tibia, or humerus.

Posterior rib fracture

A fracture near the costovertebral junction in an infant, highly concerning for abuse because it requires significant force and is uncommon from accidental trauma.

Abusive head trauma

Inflicted injury to the skull or brain, often with subdural hemorrhage and retinal hemorrhage, caused by shaking, impact, or both, typically in infants.

Retinal hemorrhage evaluation

Dilated indirect ophthalmoscopy by an ophthalmologist; extensive, multilayered hemorrhages in a young infant without major accidental trauma raise concern for abusive head trauma.

Skeletal survey timing

Obtain a complete skeletal survey in children younger than 2 years with suspected abuse and repeat it about 2 weeks later to detect healing fractures.

Occult abdominal trauma labs

Measure ALT, AST, lipase, and urinalysis in suspected abuse; abnormal results or symptoms warrant imaging such as CT to detect liver, pancreatic, or renal injury.

Bleeding disorder workup

Check CBC, PT, PTT, INR, and fibrinogen before attributing unexplained bruising or bleeding to abuse, especially when the pattern is atypical.

Delayed disclosure

Children often delay reporting sexual abuse, recant, or never disclose; absence of disclosure or physical findings does not exclude abuse.

Hymenal transection

A complete cleft through the hymen to its base, a concerning finding for penetrating trauma, though many sexually abused children have normal examinations.

Sexual assault evidence collection

Follow local protocol; DNA evidence may be collected up to 72 hours or longer, with STI prophylaxis and emergency contraception offered as indicated.

Prepubertal STI significance

In a prepubertal child, vaginal chlamydia or gonorrhea beyond the neonatal period is diagnostic of sexual contact and must be reported.

Forensic interview

A non-leading, developmentally appropriate interview conducted by a trained professional at a child advocacy center, ideally recorded to reduce repeated questioning.

Child sexual exploitation

Sexual abuse involving exploitation, such as child sexual abuse material, trafficking, grooming, or online solicitation, and it requires reporting to authorities.

Anogenital exam positions

Use supine frog-leg and prone knee-chest positions with labial traction; repeat examination may be needed, but avoid unnecessary traumatic exams.

Neglect definition

Failure to provide for a child's basic physical, medical, educational, or supervisory needs, the most common form of maltreatment, often chronic and cumulative.

Growth faltering

Weight or length below expected for age or crossing percentiles downward; evaluate organic causes, feeding problems, and psychosocial factors using growth charts.

Medical neglect

Failure to seek or follow through with necessary medical care, while distinguishing barriers such as cost, transportation, and health literacy from willful neglect.

Supervisory neglect

Leaving a child unsupervised or with an inadequate caregiver for the child's developmental age, considering hazards, duration, and the child's needs.

Physical neglect signs

Poor hygiene, inadequate clothing, malnutrition, untreated dental disease, or unsafe shelter; document findings and consider family stressors such as poverty.

Neglect risk factors

Poverty, parental substance use, mental illness, domestic violence, and social isolation increase risk, but poverty alone does not establish neglect.

Failure to thrive admission

Hospital admission may be used for observed feeding, weight monitoring, and multidisciplinary assessment when outpatient evaluation is inconclusive or safety is uncertain.

Psychological maltreatment types

Patterns include spurning, terrorizing, isolating, exploiting or corrupting, denying emotional responsiveness, and neglecting mental health, medical, or educational needs.

Factitious disorder imposed on another

A caregiver falsifies or induces illness in a child to assume the sick role, formerly called Munchausen syndrome by proxy, and it constitutes abuse.

FDIA red flags

Symptoms occur only with the caregiver, laboratory results are inconsistent, multiple providers are involved, and unusual infections or unexplained bleeding appear.

FDIA management

Report to child protective services, separate the child from the caregiver, review all records, and arrange multidisciplinary and psychiatric evaluation.

Psychological maltreatment effects

It harms attachment, brain development, self-regulation, and mental health, and it often coexists with physical abuse or neglect.

Mandated reporting threshold

Report when there is reasonable suspicion of abuse or neglect, not proof; good-faith reports are legally protected, and reporting does not end the medical evaluation.

Chain of custody

Document each transfer of forensic evidence, specimens, or photographs to preserve admissibility, using sealed containers, labels, and signatures.

Child advocacy center

A coordinated site where forensic interviews, medical exams, mental health care, and victim advocacy occur as a multidisciplinary team response.

AHT prevention program

The Period of PURPLE Crying educates caregivers about normal infant crying and the danger of shaking, reducing abusive head trauma through universal hospital-based teaching.