Forensic Child Abuse 2022 PDF

Forensic 2022 up to date Child abuse M.Khalil  child abuse Can be physical, sexual ,emotional or physical neglect (types) non accidental injury (trauma), maltreatment syndrome, battered baby or battered child syndrome or shaken baby syndome often abused by...

Forensic 2022 up to date Child abuse M.Khalil  child abuse Can be physical, sexual ,emotional or physical neglect (types) non accidental injury (trauma), maltreatment syndrome, battered baby or battered child syndrome or shaken baby syndome often abused by caretaker eg: parents or other family members (close relative) Munchausen Syndrome by proxy: 98% of perpetrators are mothers Is false reporting of symptoms in a child by caretaker or infliction of medical signs Goal is subconscious desire by Caretaker for attention Very difficult to cure the caretaker mortality 9% >>> history of unusual death in a sibling factors related to child abuser :- 1)teenage parent (emotionaly immature) 2)single parent (divorced or separated) 3)Low socioeconomic 4)Drug or alcohol abuser 5) Arrested for violence acts and history of violence in the family 6)crowded household 7)Low self esteem 8)Themself abused as achild 9)Recent loss of job or family member 10)Depression, poor impulse control or unrealistic expectations 11)unstable and insecur family  most abusers are male may target both male and female children. They abuse many different victims. often choose to work and live in areas where there are many children present Factors related to abused child: 1) female. low weight & short stature withdraw, passive & quite child features of the medical history which indicate child abuse : 1)Delay between time of injury & presentation (Delayed bringing the child to the hospital) 2)History not Consistent with severity or type of injury (Discrepancy between the history and clinical finding) (vague history) 3)History of multiple or recurrent prior injuries (most important) 4)Different history of injury from caretakers & Story keep Changing (History changes when asked again) 5)caretakers react inappropriately to situation either under or over reaction 6)caretaker do not Know etiology of the injury 7)child is afraid of caretaker physical examination findings indicative of possible child abuse: 1)multiple injuries of various ages (most important) eg: Bruises in different stages in areas not over bony prominances. most Common skin lesion and diagnostic for child abuse is multiple bruises of various ages 2)perioral, perineal, anal or genital injuries 3)sharply demarcated burns (upper demarcations) >>> Scald (hot water) NoT dry burn 4)Black eye (raccoon eye) (panda eye) 5)ShaKen baby syndrome >>> Recently >>> shaken impact syndrome Diagnostic criteria: A)Retinal Hemorrhage 80% (while 3 % in accidental head trauma) B)finger pad bruises C)multiple rib fractures D)subdural Hge >>> coma and seizure without obvious evidence of scalp trauma 6)Head trauma in Child abuse ( 10 % ) most common (leading cause)of death SKull fracture: A) second common skeletal injuries after limb fracture that’s why whole body skeletal X-ray survey is necessary B) classical head injury 7) Abdominal trauma >>> 2nd common cause of death DDX is bone diseares and skin diseases due to hematological problem mouth examination is Very important >>> The frenulum behind the midline of the upperlip >>> rupture due to blow across the upperlip or slap across the mouth.  bruises and tears around the frenulum and the floor of the mouth pinches on limbs called butterfly bruises Don’t forget that the most common burns in child abuse is scalding not dry burn