Assessment for Child Abuse

Listening as well as observation is a skill that must be perfected to perform a good, thorough assessment. One patient I had felt her stress was due to her work environment however she also related that she was a newly diagnosed diabetic and probably the most important information in the interview was the revelation of a sisters death; a sister she thought of as her best friend. This event seemed to alter her ability to cope. When doing any assessment, paying attention to every word, emotional display, body movement and physical finding can lead to clues regarding the patients mental and physical health, but will also assist in the recognition of the smallest details in a forensics exam. When a child or young adolescent presents with vague physical symptoms or new behavioral problems, do we do an oral exam to see if the child as been abused or assaulted; being forced to perform oral sex. While working with the Inuit in AK, oral exams became part of the routine health-screening exam as a clue to diet and nutrition. Many children had multiple caries secondary to the enormous sugar consumption. Was this neglect or cultural mores? We look for severe nail biting as signs of stress in children as well as adults despite patients’ denials, cigarette stains with those who smoke occasionally, poor skin turgor or dry mucous membranes with the patient who tells us they drink lots of fluids. Good assessment skills should help us identify multiple conditions and/or problems by reading between the lines with all our clinician tools.

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