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“The physical or mental injury, sexual abuse or exploitation, negligent treatment, or maltreatment of a child under the age of 18 by a person who is responsible for the child’s welfare under circumstances which indicate that the child’s health or welfare is harmed or threatened.”

acts of commission and omission. injuries :

blunt force sharp force thermal injuries

Acts of omission lead to :malnutrition, dehydration, infection, growth retardation, etc

The most common form is neglect

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Physical Abuse

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may include :

beatings, ,shaking, human bites

welts

burns

immersion in scalding water or others

Strangulation

resulting :

bruises

Scars

Burns

Fractures

internal injuries

any other injuries.

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‘‘battered child syndrome’’ : clinical manifestations of serious

physical abuse in young children.

any non-accidental injury to a child under the

age of 18 by a parent or caretaker.

generally applied to children showing repeated & devastating injury to the skin,skeletal ,

nervous system, severe visceral trauma.

The tight grasp around the chest that accompanies this shaking may also cause rib fractures these are also highly specific for

abuse. may be incidentally found on chest X-

rays performed for other reasons, such as to evaluate for pneumonia.

Skin and Soft Tissue Injury Bruises in areas where normal childhood

activities would not usually result in bruising bruises on:

face, lips, mouth, raccoon eyes torso, back, buttocks, thighs

especially if in various stages of healing degree of bruising is greater than expected for the

activity level of the child patterned bruise (of inflicting instrument such

as belt buckle, hairbrush, or hand , fingers) Circular marks around wrists or ankles

(indicating twisting or tying up) Choke marks around neck Black eyes in shaken baby syndrome or a

direct blow to the head

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BruisesBruises

Laceration of frenulum :an important marker of impact to the face and an indicator of violence imparted on a child.

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Human bite marks leave concentric bruises that contain individual teeth marks.

If the point-to-point distance between the canines (eye teeth) is greater than 3.0 cm, the injury was inflicted by someone with permanent teeth.

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Thermal injury

Scalding marks:

the most common Hot water (With a water temperature

of 130- 145 degrees or greater) can cause deep burns very quickly

child is placed in hot water as a punishment -- particularly "glove" or "sock" burn patterns

sparing of the creases in regions of skin foldssharp line of demarcation between the burned

and the unburned skin.

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electric stove, radiator, heater,iron or other hot objects:usually seen on the child's hands, arms

or buttocks

Cigarette burns on :exposed areas especially on

palms, soles of feetgenitals Backbuttocks

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sparing of the creases in regions

of skin folds

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Usually markers of direct impact injury to the head. Accidental skull fractures associated with activities

of daily living : generally simple linear fractures without associated

severe brain injury. Complex skull fractures:

wide gaping linear Branching comminuted Basilar Depressed multiple fractures

Complex skull fractures generally associated with : motor vehicle accidents falls from great heights inflicted injuries.

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In infants and small children, does not usually form a large hematoma.

typical markers of severe head injury (SDH,SAH) maybe without evidence of impact (such as scalp contusion or skull fracture): impacted a flat, soft surface severely shaken resistantancy of elastic tissues to bruising

and tearing

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Skeletal survey to show skull fractures CT w/o contrast for acute injuries MRI is more sensitive than CT for

detecting contusions, traumatic venous thrombosis, and older injuries

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Corner FX Bucket handle fx

Healing rib FX

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Internal organs injury

Commonly caused by blunt trauma injury to liver, spleen, adrenal glands small bowel injury :

duodenal or jejunal hematoma bowel laceration

pancreatitis or pancreatic injury Use CT first Other follow up studies may be

necessary

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Sodomy

Oral-genital

stimulation

Verbal stimulation

Exhibitionism

SEXUALLY ABUSIVE BEHAVIORSSEXUALLY ABUSIVE BEHAVIORS

VoyeurismVoyeurism

FondlingFondling

Child prostitutionChild prostitution

Child pornographyChild pornography

IntercourseIntercourse

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Emotional Abuse

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Neglect

failure of a parent to provide for the development of the child in the following areas:nutrition Health careDucationemotional developmentshelter

Neglect is thus distinguished from circumstances of poverty in that neglect can occur only in cases where reasonable resources are available to the family or caregiver.

Death

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Head injuries are the most common cause of death from child abuse

Abdominal injury is the second most common cause of death among battered children.Ruptures of the spleen, liver , bladder or

bowel caused by a punch or kick can result in the

above with no visible bruises or marks on the abdomen in over half the cases.

with increasing age (0 through 5 years), decreasing incidence of head injury and increasing incidence of abdominal injury.

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Differntial diagnosis

Unintentional vs intentional Unintentional vs intentional injury:injury: injuries occur during the course of normal daily

activities such as playing, and short falls, are not serious and do not prove to be fatal.

Diseases

CPR-related trauma

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Diseases :Osteogenesis imperfectaScurvyRicketsMenke’s syn.SyphilisPhysiologic periostitis of infancy

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به موجب قانون حمایت از کودکان و نوجوانان مجلس شورای اسالمی ،هر ۲/۱۱/۱۳۸۱مصوب

گونه آزار و اذیت کودکان و نوجوانان که موجب ایراد صدمه جسمانی یا روانی و اخالقی به کودک

شده و سالمت جسمانی یا روانی کودک را به خطر اندازد ممنوع و مستوجب تعزیر می باشد.

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در این قانون موارد کودک آزاری را مشمول مواردنادیده گرفتن عمدی سالمت و بهداشت روانی و

جسمانی کودک،هرگونه آسیب و شکنجه جسمی و روحی،سوء استفاده از کودکان برای قاچاق ،خرید

و فروش کودکان و هرگونه بهره کشی و به کارگماری آنان به بهانه تامین معیشت ،ممانعت از

تحصیل و هر گونه تبعیض که منجر به صدمه روانی یا توقف رشد طبیعی کودک گرددو اعمالی از این قبیل که سبب سلب آزادی های شرعی و قانونی

شود ، قرار داده است.

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کودک آزاري از جرايم عمومي است، و احتياج بهشکايت شاکي خصوصي ندارد، يعني دادستان

درصورت آگاهي از کودک آزاري به هر نحو ازجانب هر کسي که باشد دخالت مي کند.

ماه حبس و جريمه نقدي (يك 6مجازات آن كه میلیون تومان ) براي فرد خاطي در نظر گرفته

شده

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کليه افراد و موسسات و مراکزي که به نحويمسئوليت نگاهداري و سرپرستي کودکان را

برعهده دارند مکلف اند به محض مشاهده موارد کودک آزاري مراتب را جهت پيگرد قانوني مرتکب

و اتخاذ تصميم مقتضي به مقامات صالح قضايي 6اعالم کنند، تخلف از اين تکليف موجب حبس تا

ميليون ريال خواهد بود.5ماه يا جزاي نقدي تا

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هرگونه خريد، فروش، بهره کشي، و به کارگيريکودکان به منظور ارتکاب اعمال خالف از قبيل

قاچاق و... ممنوع و مرتکب حسب مورد عالوه بر ماه تا يک سال زندان يا جزاي 6جبران خسارت به

ميليون ريال محکوم 20 ميليون تا 10نقدي از خواهد شد.

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درصورت ارتکاب قتل فرزند توسط ولي به لحاظجلوگيري از تجري مجرمان بالقوه مي تواند طبق

قانون عالوه بر پرداخت ديه و يک الي ده سال حبس محکوم شود و اين حبس مجازات تعزيري

است ،ولي دم هم شامل پدر وهم مادر مي شود

خاطرنشان کرد: پدر به دليل پدر و سرپرست بوده قصاص نمي شود اما در صورت ارتکاب قتل فرزند

توسط مادر، وي قصاص خواهد شد.

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