Child Abuse Identification and Reporting: The Pennsylvania Requirement _____________________________
Bodily Injury Bodily injury, or physical abuse injuries, can range from minor bruises and lacerations to severe neurologic trauma and death. Physical abuse is one of the most easily identifiable forms of abuse and the type most commonly seen by healthcare profes- sionals. Physical injuries that may be indicative of abuse include bruises/welts, burns, fractures, abdominal injuries, lacera- tions/abrasions, and central nervous system trauma [8; 34]. Bruises and welts are of particular concern, especially those that appear on: • The face, lips, mouth, ears, eyes, neck, or head • The trunk, back, buttocks, thighs, or extremities • Multiple body surfaces Patterns such as the shape of the article (e.g., a cord, belt buckle, teeth, hand) used to inflict the bruise or welt are com- mon. Cigar or cigarette burns may be present, and they will often appear on the child’s soles, palms, back, or buttocks. Patterned burns that resemble shapes of appliances, such as irons, burners, or grills, are of concern as well. Fractures that result from abuse might be found on the child’s skull, ribs, nose, or any facial structure. These may be multiple or spiral fractures at various stages of healing. When examining patients, note bruises on the abdominal wall, any intestinal perforation, ruptured liver or spleen, and blood vessel, kidney, bladder, or pancreatic injury, especially if accounts for the cause do not make sense. Look for signs of abrasions on the child’s wrists, ankles, neck, or torso. Lacerations might also appear on the child’s lips, ears, eyes, mouth, or genitalia. If violent shaking or trauma occurred, the child might experience a subdural hematoma [8; 34].
‒ Looking at the sexual or other intimate parts of a child or another individual for the purpose of arousing or gratifying sexual desire in any individual ‒ Participating in sexually explicit conversation either in person, by telephone, by computer, or by a computer-aided device for the purpose of sexual stimulation or gratification of any individual ‒ Actual or simulated sexual activity or nudity for the purpose of sexual stimulation or gratification of any individual ‒ Actual or simulated sexual activity for the purpose of producing visual depiction, including photographing, videotaping, computer depicting, or filming • Any of the following offenses committed against a child: ‒ Rape ‒ Statutory sexual assault ‒ Involuntary deviate sexual intercourse ‒ Sexual assault
‒ Institutional sexual assault ‒ Aggravated indecent assault ‒ Indecent assault ‒ Indecent exposure ‒ Incest ‒ Prostitution ‒ Sexual abuse ‒ Unlawful contact with a minor ‒ Sexual exploitation
According to the American College of Radiology, fractures highly suggestive of physical abuse include rib fractures, classic metaphyseal lesions, those unsuspected or inconsistent with the history or age of the child, multiple fractures involving more than one skeletal area, and fractures of differing ages.
This does not include consensual activities between a child who is 14 years of age or older and another person who is 14 years of age or older and whose age is within four years of the child’s age. Child sexual abuse can be committed by a stranger or an indi- vidual known to the child. Sexual abuse may be manifested in many different ways, including [9; 10]: • Verbal: Obscene phone calls or talking about sexual acts for the purpose of sexually arousing the adult perpetrator • Voyeurism: Watching a child get dressed or encouraging the child to masturbate while the perpetrator watches • Child prostitution: Involving the child in sexual acts for monetary profit • Child pornography: Taking photos of a child in sexually explicit poses or acts • Exhibitionism: Exposing his/her genitals to the child or forcing the child to observe the adult or other children in sexual acts
(https://acsearch.acr.org/docs/69443/Narrative. Last accessed July 26, 2022.) Level of Evidence : Expert Opinion/Consensus Statement
Sexual Abuse/Exploitation According to the Pennsylvania Code, sexual abuse or exploita- tion is defined as [45]: • The employment, use, persuasion, inducement, enticement, or coercion of a child to engage in or assist another individual to engage in sexually explicit conduct, which includes, but is not limited to, the following:
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Book Code: DPA1525
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