child abuse & neglect: essential information for practicing

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CHILD ABUSE NEGLECTESSENTIAL INFORMATION FOR
PRACTICING PRESIDING IN CHILD WELFARE CASES

• KAREN T. CAMPBELL, MD
• FORENSIC PEDIATRICIAN
• MEDICAL DIRECTOR, CYFD/PS
• CO-MEDICAL DIRECTOR UNM CART

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Incidence and Prevalence

• There were approximately a million victims of
  Child Maltreatment in 2005 in the United States.
• The rate of victimization in the United States is
  12.1 children per 1000 children.

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Further breakdown of statistics

• In the United States-
• 54 of the children suffered from neglect
• 23 were physically abused
• 12 were sexually abused.
• Highest victimization rates were in the 0-3 year
  age group.

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In New Mexico

• The child population in New Mexico was 489,482
  in 2005
• 32,950 children were the subject of a report for
  abuse/neglect in 2005
• During the same year the rate of substantiation
  was 14.9 per 1000 children
• 12 children died as a result of abuse/neglect
  during 2005

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Remember, every day in America, four (4) children
die as a result of abuse and neglect!
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• INJURIES IN CHILD ABUSE

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Examples of External Injuries

• Contusions
• Abrasions
• Lacerations
• Incisions
• Thermal/Chemical/Scald Burns

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Examples of Internal Injuries

• Fractures
• Contusion
• Laceration
• Incision
• Ischemia
• Edema
• Hemorrhage

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Common sites of Accidental Injuries

• Forehead
• Forearms
• Elbows
• Spinal Prominences
• Hips / Iliac Crest
• Knees
• Shins

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Common sites of Non-Accidental Injuries

• Face
• Ears
• Neck
• Upper Arms
• Back
• Chest and Abdomen
• Upper legs
• Buttocks
• Genitalia

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Differentiating between Accidental and
Non-Accidental Trauma

• Age and/or developmental capability of the child
• Parent/Caretaker explanation for how the injury
  occurred
• Type of Injury
• Location of Injury
• Risk Factors-
• Infant/Child and Parent/Caretaker

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Child Abuse Work-up

• History
• Complete Physical Exam
• Skeletal Survey
• Head CT Scan
• Bone Scan
• MRI/MRA of the Head and Neck
• Ophthalmology Exam
• Chest/Abdominal CT Scan
• Laboratory Studies
• Genetics/Dysmorphology Consult

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• ABUSIVE HEAD INJURY

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NORMAL RETINA
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• Corner Metaphyseal Fracture

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• FRACTURES

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• PATTERNED INJURIES

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• BURNS

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• CONDITIONS MISTAKEN
• FOR
• CHILD ABUSE

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• CHILD NEGLECT

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DEFINITION OF NEGLECT

• Historically, neglect has been difficult to
  define
• Definitions have varied across states,
  disciplines, agencies, and individuals
• Broadly stated, neglect is a condition where a
  childs basic needs are not being met by their
  parent(s) or caretaker(s)

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TYPES OF NEGLECT

• Physical Neglect
• Inadequate food and housing
• Adult substance abuse
• Domestic violence
• Failure to Thrive (FTT)
• Educational Neglect
• Truancy and school absences
• Non-approved home schooling
• Emotional Neglect
• Medical Neglect
• Lack of appropriate Well Child Care and
  immunizations
• Lack of appropriate medical care for acute and
  chronic medical conditions

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FAILURE TO THRIVE (FTT)

• Growth failure from malnutrition
• Drop of 2 or more standard deviations on a
  standard growth chart
• Weight at less than the 3rd percentile
• Can be organic or non-organic
• Can be a combination of organic and
  non-organic

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RISK FACTORS IN FAILURE TO THRIVE

• Medical
• Chronic medical conditions
• Illnesses, inborn errors of metabolism, heart
  disorders, pulmonary disorders, kidney disorders,
  genetic disorders
• Congenital anomalies
• Poverty
• Parent-child interactive disorders
• Family dysfunction
• Parental mental health disorders
• Parental characteristics
• Child characteristics

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WORK-UP FORFAILURE TO THRIVE

• Complete history
• Birth history, maternal prenatal history, past
  medical history of the child, family history,
  feeding history, feeding behaviors
• Medical work-up as indicated by complete history
• If no organic etiology is indicated by history,
  placing the child in the hospital, or other
  environment, and following the childs weight on
  an age-appropriate diet

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• For further information or questions, please feel
  free to contact me at
• [phone] office
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