Risk Factor

⛳ Red Flags

Suspicious Individual Injury

THOSE WHO DON’T CRUISE, RARELY BRUISE

Pediatric Fracture

Sexual Assault

Ovver 90% of children who have disclosed sexual abuse will have a normal physical examination. This does not mean that abuse has not occurred.

Investigation and Management

• For every children < 2 yr, order a Skeletal survey to look for occult fractures if have any suspicion

1. Undress the child and conduct head-to-toe exam

   

2. Consult other specialties

   

   • Opthal: !Retinal hemorrhage may be a sign of violate shaking
   • Endocrine: Multiple fracture may be due to underlying Metabolic Disorder

3. Confidentiality & Mandatory Reporting

   <aside>

   • **CAS https://www.torontocas.ca/**
     1. Help getting social support
     2. Help them defining health goal and figure out what they want
     3. Address the abuse
   • Considerations
     • Reasonable ground: more likely than not likely
     • Zone of Parental Discretion: https://bioethics.pitt.edu/sites/default/files/publication-images/Messer2019/Resources/Session 4, Gilliam (2016) The zone of parental.pdf (is this just non-ideal parent or actually abuse?)
   • Strategy:
     • Involve dedicated team in the hospital, ask for help
     • Involve the parents in the call
     • Explain what
     • For indigenous population: contact alternative support groups (NO CAS)
       • Social Worker
       • Indigenous Health Navigator </aside>