Child Neglect and Abuse

Mandy is a 6-year-old who has been brought in by her new foster mother for a well-child exam. The foster mother states that Mandy was removed from her home due to neglect and physical and sexual abuse.

What types of abnormal behaviors might Mandy exhibit?

Children who have experienced neglect and physical or sexual abuse can exhibit various abnormal behaviors due to their traumatic experiences. Since Mandy has experienced abuse and neglect, she may exhibit behaviors such as aggression, fear, anxiety, withdrawal, regression, and sleep problems. She may show mood swings or tantrums when interacting with other people. He may also appear nervous and exhibit behaviors typical of a younger age, such as baby talk, thumb-sucking, and bedwetting. The traumatic experiences may also subject Mandy to nightmares and sleeping difficulties.

What physical findings might you find during the physical examination?

Some potential findings during examination include sexual abuse indicators, recurrent infections, and visible signs of physical injuries. Signs of sexual abuse may include pain in her genitals or unusual toileting habits. Mandy can also suffer from delayed growth due to neglect or malnutrition and concomitant recurrent infections like urinary and skin disorders. Other physical findings can be burns, cuts, and bruises.  

How should you manage Mandy’s history of abuse?

The first thing I would do to manage Mandy’s history of abuse is to ensure her safety by providing a stable and supportive environment. I would also engage her in therapy or counseling suitable for her age. This can help me address the mental and emotional impact of her neglect and abuse. I would undertake medical care to address any physical injuries or health issues that may have emanated from the experience. I would also educate the foster mother on how to support Mandy by managing any abnormal behavior or emotional challenges.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care.

Questions to ask Mandy and the foster mother

I would ask open-ended questions to collect information about Mandy’s abuse and neglect experiences and her well-being. These include:

  • Are there any specific triggers or situations that appear to upset Mandy?
  • Is she experiencing any toileting discomforts or difficulties?
  • Does she exhibit any sleep disturbances, night sweats, or nightmares?
  • Does Mandy have any history of medical conditions or allergies?
  • Does she have any pain or discomfort in specific areas of her body?
  • Has she been receiving any therapy or counseling?
  • How does Mandy interact with adults and her peers?
  • How are is behavior and mood at home and at school?

Physical examination elements

  • Carry out the physical examination in a child-friendly manner
  • Scrutinize for any signs of physical injuries, such as burns and bruises
  • Examine the anal and genital areas to find any signs of sexual abuse
  • Measure her weight, height, and other growth parameters to figure out any growth issues
  • Examine her overall physical health

Further testing:

Based on the findings of the physical examinations, further testing may include laboratory tests and X-rays. 

Differential and working diagnosis:

Treatment plan:

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

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