CHILD ABUSE & NEGLECT:ESSENTIAL INFORMATION FOR

PRACTICING & PRESIDING IN CHILD WELFARE CASES

KAREN T. CAMPBELL, MDFORENSIC PEDIATRICIAN

MEDICAL DIRECTOR, CYFD/PSCO-MEDICAL DIRECTOR UNM CART

IncidenceIncidence andand PrevalencePrevalence

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.

Further breakdown of Further breakdown of statistics…statistics…

In the United StatesIn 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.

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

Remember, every day in America, four (4) children die as a result of abuse

and neglect!

INJURIES IN CHILD ABUSE

Examples of External Injuries

Contusions Abrasions Lacerations Incisions Thermal/Chemical/Scald Burns

Examples of Internal Injuries

Fractures Contusion Laceration Incision Ischemia Edema Hemorrhage

Common sites of Accidental Injuries

Forehead Forearms Elbows Spinal Prominences Hips / Iliac Crest Knees Shins

Common sites of Non-Accidental Injuries

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

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

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

ABUSIVE HEAD INJURY

NORMAL RETINA

Corner Metaphyseal Fracture

FRACTURES

PATTERNED INJURIES

BURNS

CONDITIONS MISTAKENFOR

CHILD ABUSE

CHILD NEGLECT

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 child’s basic needs are not being met by their parent(s) or caretaker(s)

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

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”

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

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 child’s weight on an age-appropriate diet

For further information or For further information or questions, please feel free to questions, please feel free to

contact me at: contact me at:

(505) 841-7755 office (505) 841-7755 office

(505) 540-9577 pager (505) 540-9577 pager