Dítě ohrožené prostředím Týrané, zneužívané a zanedbávané děti

Child abuse and neglect
Motto
• If anyone causes one of these little ones to
stumble, it would be better for them to have a
large millstone hung around their neck and to
be drowned in the depths of the sea.Matthew,
18, 6)
• Child abuse is the difference between a fist in
the face and a hand on the bottom . (H.
Kempe)
Definition
A child is abused if an adult behaves to him/her
ia away unacceptable in a given time and
given society.
Epidemiology
• Worldwide assessment - WHO – 40 mil.
Children younger 15 years
• Corporal punishment
– Households 80 %,
– Serious 30 %
Death due to CAN
(source: UNICEF, 2003)
Úmrtí/100000 dětí
4
3,5
3
2,5
2
1,5
1
0,5
0
Abused children - statistics
• incidence
– UK - 4 % younger 12 years
– USA 4,94 % population under 18 years
– EU – cca 9 % pediatric population
– Validity ????
• UK – 4 chidren die every week as a result of
CAN
Risk factors
• Child
– Age under 3 years
– Handicap
– First child
• Parents
–
–
–
–
–
Mental disease
Drug/alcohol abuse
? Powerty, social status?
Dependence on abuser
History of CAN
Neutral factors
• Sex of the victim
– Specifics of sexual abuse
• Education and social status of the parents
Protective factors
• Support in wider family
• Fear of child
CAN
•
•
•
•
•
Physical abuse ( nonaccidental injury)
Neglect
Sexual abuse
Emotional abuse
Munchhausen sy by proxy
Physical abuse (WHO)
• Any stoke to the head
• Any stroke with an object
• Stoke by a hand to the body with more
serious outcome than transient skin redness
Physical abuse
•
•
•
•
•
•
•
Hitting – hand, fist
Hitting by an object
fractures
biting
cutting
High temperature
suffocating
Suspicious hematomas
• Infant under 7 months
• Localisation on „soft“
parts of the body,
genital area or
sumbmental area
• Specific shapes
• Multiple hematomas
and bruises of different
age
Shapes
Differential diagnosis
• Bleeding
– PT, APTT, Blood count (thrombocytes)
• Accidental injury
• HS purpura
Dif. dg. - coagulopathy
HS purpura and ITP
Biting
• Children ( distance of canine teeth less than
2,5 cm)
• Adults
• Animals (shape, depth)
• Self-injury
Burns
• Liquid ( insertion, spills)
• Direct effect of flame
• Hot object
Shapes
Dif dg
Fractures
•
•
•
•
Skull
Epiphyseolysis
Ribs
Old fractures
Neglect
–
–
–
–
–
–
Hygiene
Feeding
Clothing
Accomodation
Education
Health care
Sexual abuse
•
•
•
•
•
Exhibicionism
Harassment
Sexual attack
Rape
Incest
• Sexual tourism
Emotional abuse
• Better a meal of vegetables where there is
love than a fattened calf with
hatred.(Proberbs, 15, 17)
• Absence of love
• No interest, coldness
• Hypercriticism
• Comparation
• Unreal goals
Műnchausen syndrome by proxy
• Health care
professionals
• Symptoms:
–
–
–
–
GIT (diarhoe, bleeding)
Hematuria
Skin
Systemic (sepsis)