As per the World Health Organization (WHO) definition, child maltreatment encompasses various forms of harmful behavior and actions against children, including emotional, physical, sexual, neglect, and exploitation. These forms of abuse can result in actual or potential harm to the child’s overall well-being, growth, and dignity.
The primary categories of child abuse include neglect, physical, psychological, and sexual abuse. It is important to note that abuse refers to deliberate actions that cause harm, while neglect refers to the failure to provide proper care, leading to possible harm to the child.
Epidemiology
The prevalence of childhood adverse experiences (ACE) can vary across different populations and regions. Numerous studies have assessed the prevalence of ACEs in various countries. The original ACEs study, conducted by the Centers for Disease Control and Prevention and Kaiser Permanente in the mid-1990s in the United States, found that around 64% of participants reported at least one ACE and more than 20% reported three or more ACEs.
A study conducted by Public Health Wales in 2015 found that approximately 47% of adults in Wales reported at least one ACE. Physical abuse and household dysfunction were the most commonly reported experiences. The Canadian ACE Study conducted in 2013 found that 62% of adults reported at least one ACE.
Emotional abuse and household dysfunction were the most prevalent ACEs. The Australian Institute of Family Studies conducted a study in 2016 and reported that approximately 46% of Australians had experienced at least one ACE. Neglect and household dysfunction were the most common ACEs reported.
Anatomy
Pathophysiology
Etiology
Child abuse affects individuals from all races, ethnicities, and socioeconomic backgrounds; however, it is more commonly experienced by boys and adolescents. Infants are particularly vulnerable to physical abuse, leading to severe morbidity and mortality. Multiple factors influence the risk of child abuse. For example, children living in households with unrelated adults or those previously reported to child protective services (CPS) are at higher risk of maltreatment.
These factors contribute to an increased likelihood of child abuse occurring. On the other hand, there are protective factors that can decrease the risk of child maltreatment. Strong family support systems and parental concern play a significant role in safeguarding children from abuse. When parents are actively engaged and demonstrate a genuine interest in their child’s well-being, it creates a protective environment. Preventive measures are also crucial in reducing the risk of child maltreatment.
Parental education about child development and effective parenting techniques is essential in promoting healthy parent-child relationships and reducing the likelihood of abuse. Social support systems that provide families assistance, guidance, and resources can also serve as preventive factors. Additionally, parental resilience, the ability to cope with stress and adversity, is crucial in preventing child abuse.
Genetics
Prognostic Factors
Clinical History
Clinical History
Physical Abuse
The mnemonic “TEN 4” is helpful to remember specific locations where bruising in cases of physical abuse should raise concern. “TEN 4” stands for Torso, Ear, Neck, and 4 (referring to children under the age of four or any bruising in infants under four months old). Certain injuries are highly indicative of abuse, including posterior rib fractures, retinal hemorrhages, and classic metaphyseal lesions.
Bruising is the most commonly observed sign of physical abuse, but it is often overlooked as a warning sign in mobile children. In contrast, bruising is relatively uncommon in non-ambulatory children, and its presence should raise suspicion for abuse. In non-abused children, bruises commonly appear on the shins, knees, and bony prominences such as the forehead.
However, in cases of abuse, the head and face are frequently affected areas. Burns are another type of childhood injury not usually associated with abuse. However, immersion burns exhibit distinct characteristics that are highly suggestive of abuse. These burns often display sharp lines of demarcation and involve the genital and lower extremity regions symmetrically. The presence of such patterns raises significant suspicion of abuse.
Abusive Head Trauma
Abusive head trauma (AHT), commonly referred to as shaken baby syndrome, is a severe form of physical abuse that has the highest mortality rate among child abuse cases. Several findings indicate AHT, including retinal hemorrhages, subdural hematomas, and diffuse axonal injury. These specific medical findings strongly suggest the child has experienced abusive head trauma.
Physical Examination
Physical Examination
Abdominal Trauma
Abdominal trauma poses a significant risk of morbidity and mortality in children who have experienced abuse. It is the second leading cause of death from physical abuse, primarily observed in infants and toddlers. Detecting abdominal trauma in these cases can be challenging as many affected children do not exhibit obvious physical signs such as abdominal bruising during a physical examination.
Therefore, a comprehensive screening approach should be employed, including liver function tests, amylase, lipase, and hematuria. Positive results from these tests may indicate the necessity for further imaging studies, particularly an abdominal CT scan, to accurately assess the extent of the abdominal trauma.
Neglect
In addition to revealing signs of physical abuse, a thorough physical examination can also uncover indications of neglect. During the general examination, certain manifestations may be evident, such as poor oral hygiene characterized by extensive dental caries, malnutrition leading to significant growth failure, untreated diaper dermatitis, or unattended wounds. These findings serve as important indicators of neglect and highlight the inadequate care and attention that the child has been receiving.
Skeletal Trauma
Following neglect, physical abuse is the second most prevalent form of child abuse. A significant majority, around 80%, of abusive fractures occur in children who are unable to walk independently, particularly those under 18 months old. Age is a crucial risk factor for abusive skeletal injuries. While no definitive fracture pattern is pathognomonic of abuse, certain types of fractures are more suggestive of abusive trauma.
These suggestive fractures are lateral or posterior rib fractures or bucket or corner handle fractures. The latter occurs at the ends of long bones and typically results from twisting or rotational forces. Additionally, fractures involving the spine, sternum, and scapula are highly suspicious in cases of abuse.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential Diagnoses
Hemophilia
Osteogenesis Imperfecta
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Treatment
The physical, mental, and psychosocial needs of individuals who have experienced sexual abuse should be addressed comprehensively. It is crucial to conduct baseline testing for sexually transmitted infections (STIs) and pregnancy in these cases. Adolescent victims should receive empiric treatment for HIV, gonorrhea, chlamydia, trichomonas, and bacterial vaginosis infections, along with the option for emergency contraception if desired. This management approach is most effective when patients seek appropriate care within 72 hours of the incident.
Prophylactic treatment for STIs is not provided to prepubertal patients due to the lower incidence of these infections in this age group. However, urgent evaluation is still necessary for various reasons. This includes cases where prophylactic treatment is required, the presence of anogenital injury, forensic evidence collection, child protection concerns, and urgent medical care for patients experiencing suicidal ideation or other symptoms and injuries requiring immediate attention.
»
Home » CAD » Adverse Childhood and Adolescent Experience
Adverse Childhood and Adolescent Experience
Updated :
June 11, 2024
As per the World Health Organization (WHO) definition, child maltreatment encompasses various forms of harmful behavior and actions against children, including emotional, physical, sexual, neglect, and exploitation. These forms of abuse can result in actual or potential harm to the child’s overall well-being, growth, and dignity.
The primary categories of child abuse include neglect, physical, psychological, and sexual abuse. It is important to note that abuse refers to deliberate actions that cause harm, while neglect refers to the failure to provide proper care, leading to possible harm to the child.
The prevalence of childhood adverse experiences (ACE) can vary across different populations and regions. Numerous studies have assessed the prevalence of ACEs in various countries. The original ACEs study, conducted by the Centers for Disease Control and Prevention and Kaiser Permanente in the mid-1990s in the United States, found that around 64% of participants reported at least one ACE and more than 20% reported three or more ACEs.
A study conducted by Public Health Wales in 2015 found that approximately 47% of adults in Wales reported at least one ACE. Physical abuse and household dysfunction were the most commonly reported experiences. The Canadian ACE Study conducted in 2013 found that 62% of adults reported at least one ACE.
Emotional abuse and household dysfunction were the most prevalent ACEs. The Australian Institute of Family Studies conducted a study in 2016 and reported that approximately 46% of Australians had experienced at least one ACE. Neglect and household dysfunction were the most common ACEs reported.
Child abuse affects individuals from all races, ethnicities, and socioeconomic backgrounds; however, it is more commonly experienced by boys and adolescents. Infants are particularly vulnerable to physical abuse, leading to severe morbidity and mortality. Multiple factors influence the risk of child abuse. For example, children living in households with unrelated adults or those previously reported to child protective services (CPS) are at higher risk of maltreatment.
These factors contribute to an increased likelihood of child abuse occurring. On the other hand, there are protective factors that can decrease the risk of child maltreatment. Strong family support systems and parental concern play a significant role in safeguarding children from abuse. When parents are actively engaged and demonstrate a genuine interest in their child’s well-being, it creates a protective environment. Preventive measures are also crucial in reducing the risk of child maltreatment.
Parental education about child development and effective parenting techniques is essential in promoting healthy parent-child relationships and reducing the likelihood of abuse. Social support systems that provide families assistance, guidance, and resources can also serve as preventive factors. Additionally, parental resilience, the ability to cope with stress and adversity, is crucial in preventing child abuse.
Clinical History
Physical Abuse
The mnemonic “TEN 4” is helpful to remember specific locations where bruising in cases of physical abuse should raise concern. “TEN 4” stands for Torso, Ear, Neck, and 4 (referring to children under the age of four or any bruising in infants under four months old). Certain injuries are highly indicative of abuse, including posterior rib fractures, retinal hemorrhages, and classic metaphyseal lesions.
Bruising is the most commonly observed sign of physical abuse, but it is often overlooked as a warning sign in mobile children. In contrast, bruising is relatively uncommon in non-ambulatory children, and its presence should raise suspicion for abuse. In non-abused children, bruises commonly appear on the shins, knees, and bony prominences such as the forehead.
However, in cases of abuse, the head and face are frequently affected areas. Burns are another type of childhood injury not usually associated with abuse. However, immersion burns exhibit distinct characteristics that are highly suggestive of abuse. These burns often display sharp lines of demarcation and involve the genital and lower extremity regions symmetrically. The presence of such patterns raises significant suspicion of abuse.
Abusive Head Trauma
Abusive head trauma (AHT), commonly referred to as shaken baby syndrome, is a severe form of physical abuse that has the highest mortality rate among child abuse cases. Several findings indicate AHT, including retinal hemorrhages, subdural hematomas, and diffuse axonal injury. These specific medical findings strongly suggest the child has experienced abusive head trauma.
Physical Examination
Abdominal Trauma
Abdominal trauma poses a significant risk of morbidity and mortality in children who have experienced abuse. It is the second leading cause of death from physical abuse, primarily observed in infants and toddlers. Detecting abdominal trauma in these cases can be challenging as many affected children do not exhibit obvious physical signs such as abdominal bruising during a physical examination.
Therefore, a comprehensive screening approach should be employed, including liver function tests, amylase, lipase, and hematuria. Positive results from these tests may indicate the necessity for further imaging studies, particularly an abdominal CT scan, to accurately assess the extent of the abdominal trauma.
Neglect
In addition to revealing signs of physical abuse, a thorough physical examination can also uncover indications of neglect. During the general examination, certain manifestations may be evident, such as poor oral hygiene characterized by extensive dental caries, malnutrition leading to significant growth failure, untreated diaper dermatitis, or unattended wounds. These findings serve as important indicators of neglect and highlight the inadequate care and attention that the child has been receiving.
Skeletal Trauma
Following neglect, physical abuse is the second most prevalent form of child abuse. A significant majority, around 80%, of abusive fractures occur in children who are unable to walk independently, particularly those under 18 months old. Age is a crucial risk factor for abusive skeletal injuries. While no definitive fracture pattern is pathognomonic of abuse, certain types of fractures are more suggestive of abusive trauma.
These suggestive fractures are lateral or posterior rib fractures or bucket or corner handle fractures. The latter occurs at the ends of long bones and typically results from twisting or rotational forces. Additionally, fractures involving the spine, sternum, and scapula are highly suspicious in cases of abuse.
Differential Diagnoses
Hemophilia
Osteogenesis Imperfecta
Treatment
The physical, mental, and psychosocial needs of individuals who have experienced sexual abuse should be addressed comprehensively. It is crucial to conduct baseline testing for sexually transmitted infections (STIs) and pregnancy in these cases. Adolescent victims should receive empiric treatment for HIV, gonorrhea, chlamydia, trichomonas, and bacterial vaginosis infections, along with the option for emergency contraception if desired. This management approach is most effective when patients seek appropriate care within 72 hours of the incident.
Prophylactic treatment for STIs is not provided to prepubertal patients due to the lower incidence of these infections in this age group. However, urgent evaluation is still necessary for various reasons. This includes cases where prophylactic treatment is required, the presence of anogenital injury, forensic evidence collection, child protection concerns, and urgent medical care for patients experiencing suicidal ideation or other symptoms and injuries requiring immediate attention.
medtigo
Adverse Childhood and Adolescent Experience
Updated :
June 11, 2024
As per the World Health Organization (WHO) definition, child maltreatment encompasses various forms of harmful behavior and actions against children, including emotional, physical, sexual, neglect, and exploitation. These forms of abuse can result in actual or potential harm to the child’s overall well-being, growth, and dignity.
The primary categories of child abuse include neglect, physical, psychological, and sexual abuse. It is important to note that abuse refers to deliberate actions that cause harm, while neglect refers to the failure to provide proper care, leading to possible harm to the child.
The prevalence of childhood adverse experiences (ACE) can vary across different populations and regions. Numerous studies have assessed the prevalence of ACEs in various countries. The original ACEs study, conducted by the Centers for Disease Control and Prevention and Kaiser Permanente in the mid-1990s in the United States, found that around 64% of participants reported at least one ACE and more than 20% reported three or more ACEs.
A study conducted by Public Health Wales in 2015 found that approximately 47% of adults in Wales reported at least one ACE. Physical abuse and household dysfunction were the most commonly reported experiences. The Canadian ACE Study conducted in 2013 found that 62% of adults reported at least one ACE.
Emotional abuse and household dysfunction were the most prevalent ACEs. The Australian Institute of Family Studies conducted a study in 2016 and reported that approximately 46% of Australians had experienced at least one ACE. Neglect and household dysfunction were the most common ACEs reported.
Child abuse affects individuals from all races, ethnicities, and socioeconomic backgrounds; however, it is more commonly experienced by boys and adolescents. Infants are particularly vulnerable to physical abuse, leading to severe morbidity and mortality. Multiple factors influence the risk of child abuse. For example, children living in households with unrelated adults or those previously reported to child protective services (CPS) are at higher risk of maltreatment.
These factors contribute to an increased likelihood of child abuse occurring. On the other hand, there are protective factors that can decrease the risk of child maltreatment. Strong family support systems and parental concern play a significant role in safeguarding children from abuse. When parents are actively engaged and demonstrate a genuine interest in their child’s well-being, it creates a protective environment. Preventive measures are also crucial in reducing the risk of child maltreatment.
Parental education about child development and effective parenting techniques is essential in promoting healthy parent-child relationships and reducing the likelihood of abuse. Social support systems that provide families assistance, guidance, and resources can also serve as preventive factors. Additionally, parental resilience, the ability to cope with stress and adversity, is crucial in preventing child abuse.
Clinical History
Physical Abuse
The mnemonic “TEN 4” is helpful to remember specific locations where bruising in cases of physical abuse should raise concern. “TEN 4” stands for Torso, Ear, Neck, and 4 (referring to children under the age of four or any bruising in infants under four months old). Certain injuries are highly indicative of abuse, including posterior rib fractures, retinal hemorrhages, and classic metaphyseal lesions.
Bruising is the most commonly observed sign of physical abuse, but it is often overlooked as a warning sign in mobile children. In contrast, bruising is relatively uncommon in non-ambulatory children, and its presence should raise suspicion for abuse. In non-abused children, bruises commonly appear on the shins, knees, and bony prominences such as the forehead.
However, in cases of abuse, the head and face are frequently affected areas. Burns are another type of childhood injury not usually associated with abuse. However, immersion burns exhibit distinct characteristics that are highly suggestive of abuse. These burns often display sharp lines of demarcation and involve the genital and lower extremity regions symmetrically. The presence of such patterns raises significant suspicion of abuse.
Abusive Head Trauma
Abusive head trauma (AHT), commonly referred to as shaken baby syndrome, is a severe form of physical abuse that has the highest mortality rate among child abuse cases. Several findings indicate AHT, including retinal hemorrhages, subdural hematomas, and diffuse axonal injury. These specific medical findings strongly suggest the child has experienced abusive head trauma.
Physical Examination
Abdominal Trauma
Abdominal trauma poses a significant risk of morbidity and mortality in children who have experienced abuse. It is the second leading cause of death from physical abuse, primarily observed in infants and toddlers. Detecting abdominal trauma in these cases can be challenging as many affected children do not exhibit obvious physical signs such as abdominal bruising during a physical examination.
Therefore, a comprehensive screening approach should be employed, including liver function tests, amylase, lipase, and hematuria. Positive results from these tests may indicate the necessity for further imaging studies, particularly an abdominal CT scan, to accurately assess the extent of the abdominal trauma.
Neglect
In addition to revealing signs of physical abuse, a thorough physical examination can also uncover indications of neglect. During the general examination, certain manifestations may be evident, such as poor oral hygiene characterized by extensive dental caries, malnutrition leading to significant growth failure, untreated diaper dermatitis, or unattended wounds. These findings serve as important indicators of neglect and highlight the inadequate care and attention that the child has been receiving.
Skeletal Trauma
Following neglect, physical abuse is the second most prevalent form of child abuse. A significant majority, around 80%, of abusive fractures occur in children who are unable to walk independently, particularly those under 18 months old. Age is a crucial risk factor for abusive skeletal injuries. While no definitive fracture pattern is pathognomonic of abuse, certain types of fractures are more suggestive of abusive trauma.
These suggestive fractures are lateral or posterior rib fractures or bucket or corner handle fractures. The latter occurs at the ends of long bones and typically results from twisting or rotational forces. Additionally, fractures involving the spine, sternum, and scapula are highly suspicious in cases of abuse.
Differential Diagnoses
Hemophilia
Osteogenesis Imperfecta
Treatment
The physical, mental, and psychosocial needs of individuals who have experienced sexual abuse should be addressed comprehensively. It is crucial to conduct baseline testing for sexually transmitted infections (STIs) and pregnancy in these cases. Adolescent victims should receive empiric treatment for HIV, gonorrhea, chlamydia, trichomonas, and bacterial vaginosis infections, along with the option for emergency contraception if desired. This management approach is most effective when patients seek appropriate care within 72 hours of the incident.
Prophylactic treatment for STIs is not provided to prepubertal patients due to the lower incidence of these infections in this age group. However, urgent evaluation is still necessary for various reasons. This includes cases where prophylactic treatment is required, the presence of anogenital injury, forensic evidence collection, child protection concerns, and urgent medical care for patients experiencing suicidal ideation or other symptoms and injuries requiring immediate attention.
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