0.3 Health education course, chapter 4 - childhood psychological  (Page 2/6)

Manifestations of Abuse

History : Features suggestive of abuse are (1) parental reluctance to give a history of injury; (2) a history that may beinconsistent with the apparent stage of resolution of the injury and may vary depending on the information source; (3) a history of injury that isincompatible with the child's developmental capability; (4) an inappropriate response by the parents to the severity of the injury; and (5)delay in reporting the injury.

Physical : Common signs are skin lesions, such as ecchymoses, hematomas, burns, welts, and abrasions in various stages ofdevelopment (eg, cigarette burns, arcuate bruises from extension cord whipping, symmetric scald burns of upper or lower extremities); serioustraumatic injury to the mouth, eye, abdominal organs, and CNS, which may produce permanent damage; and fractures. Fractures may be single ormultiple, and a skeletal survey may show bony injuries in various stages of resolution. Metaphyseal fractures and subperiosteal elevations in longbones occur in infants. Major diagnostic considerations in the examination are (1) multiple injuries at different stages of resolution ordevelopment; (2) cutaneous lesions specific for particular sources of injury; and (3) repeated injury, which is suggestive of abuse or inadequatesupervision.

Physical signs of sexual abuse may include difficulty in walking or sitting, genital trauma, vaginal discharge or pruritus,recurrent UTIs, or a sexually transmitted infection. However, there may be no physical indications of injury. Sexually transmitted disease of anysort in any child<12 or 13 yr must be viewed as the result of sexual molestation until ruled out.

Emotional : Emotional manifestations of abuse are less easily defined than are physical signs. In infants, failure to thriveis a common early observation. Delayed development of social and language skills often results from inadequate parental stimulation andinteraction. Small children may be distrustful, superficial in interpersonal relationships, passive, and overly concerned withpleasing adults. The emotional impact on children usually becomes obvious at school age, when difficulties develop in forming relationships withteachers and peers. Often, emotional effects can be documented only after the child has been placed in another environment, at which time aberrantbehaviors abate.

When a child has been sexually abused, his behavior (eg, irritability, fearfulness, insomnia) may be the only clue fordiagnosis. Careful interviewing of the child by a trained professional may be the only means of adding necessary details. Older children may bethreatened with physical injury by the offender if they tell and, thus, mayconceal repeated assaults.

Manifestations of Neglect

Malnutrition, fatigue, and lack of hygiene or appropriate clothing are common due to inadequate provision of food,clothing, or shelter, despite available supportive community resources. Desertion or death by starvation is seen in extreme cases. As many as 1/2 ofinfantile failure-to-thrive cases may be due to neglect.