If bruises or contusions are present, there is no need to evaluate for a bleeding disorder if the injuries are consistent with an abuse history. Some tests can be falsely elevated, so a child abuse-specialist pediatrician or hematologist should review or follow-up these tests. The evaluation of the pediatric skeleton can prove challenging for a non-specialist as there are subtle differences from adults, such as cranial sutures and incomplete bone growth.
A fracture can be misinterpreted. If there is a concern for abuse, consider consulting a radiologist. A skeletal survey is indicated in children younger than 2 years with suspected physical abuse.
The incidence of occult fractures is as high as 1 in 4 in physically abused children younger than 2 years. The clinician should consider screening all siblings younger than 2 years. The skeletal survey should include 2 views of each extremity; anteroposterior and lateral skull; and lateral chest, spine, abdomen, pelvis, hands, and feet. A radiologist should review the films for classic metaphyseal lesions and healing fractures, most often involving the posterior ribs.
Skeletal fractures will remodel at different rates, which are dependent on the age, location, and nutritional status of the patient. If abuse or head trauma is suspected, a CT scan of the head should be performed on all children aged six months or younger or children younger than 24 months if intracranial trauma is suspected. Clinicians should have a low threshold to obtain a CT scan of the head when abuse is suspected, especially in an infant younger than 12 months.
Evaluate for evidence of dehydration, electrolyte abnormalities, infection, substance abuse, improper medication administration, and malnutrition. Domestic and family violence commonly results in the legal prosecution of the perpetrator. Preferably, a team specializing in domestic violence is called in to assist with evidence collection. Each health facility should have a written procedure for how to package and label specimens and maintain a chain of custody.
Law enforcement personnel will often assist with evidence collection and provide specific kits. It is important to avoid destroying evidence. Evidence includes tissue specimens, blood, urine, saliva, and vaginal and rectal specimens.
Saliva from bites can be collected; the bite mark is swabbed with a water-moistened cotton-tipped swab. The priority is the ABCs and appropriate treatment of the presenting complaints. However, once the patient is stabilized, emergency medical services personnel may identify problems associated with violence. The medical record is often evidence used to convict an abuser.
A poorly document chart may result in an abuser going free and assaulting again. If the patient does not want to go to a shelter, provide telephone numbers for domestic violence or crisis hotlines and support services for potential later use. Provide the patient with instructions but be mindful that written materials may pose a danger once the patient returns home.
Without proper social service and mental health intervention, all forms of abuse can be recurrent and escalating problems, and the prognosis for recovery is poor. Without treatment, domestic and family violence usually recurs and escalates in both frequency and severity. In children, the potential for poor outcomes is particularly high as abuse inflicts lifelong effects. In addition to dealing with the sequelae of physical injury, the mental consequences may be catastrophic.
Studies indicate a significant association between child sexual abuse and increased risk of psychiatric disorders in later life. The potential for the cycle of violence to continued from childhood is very high. There are multiple known and suspected negative health outcomes of family and domestic violence. There are long-term consequences to broken bones, traumatic brain injuries, and internal injuries.
It is important to be aware of federal and state statutes governing domestic and family abuse. Remember that reporting domestic and family violence to law enforcement does not obviate detailed documentation in the medical record.
Each state has specific child abuse statutes. Federal legislation provides guidelines for defining acts that constitute child abuse. The guidelines suggest that child abuse includes an act or failure recent act that presents an imminent risk of serious harm.
This includes any recent act or failure to act on the part of a parent or caretaker that results in death, physical or emotional harm, sexual abuse, or exploitation. The Elder Justice Act provides strategies to decrease the likelihood of elder abuse, neglect, and exploitation. The Act utilizes three significant approaches:. The Violence Against Woman Act makes it a federal crime to cross state lines to stalk, harass, or physically injure a partner; or enter or leave the country violating a protective order.
It is a violation to possess a firearm or ammunition while subject to a protective order or if convicted of a qualifying crime of domestic violence. Domestic violence may be difficult to uncover when the victim is frightened, especially when he or she presents to an emergency department or healthcare practitioner's office. Routine screening should be conducted by all healthcare practitioners including nurses, physicians, physician assistants, dentists, nurse practitioners, and pharmacists.
Interprofessional coordination of screening is a critical component of protecting victims and minimizing negative health outcomes. Health professional team interventions reduce the incidence of morbidity and mortality associated with domestic violence. Documentation is vital and a legal obligation. This book is distributed under the terms of the Creative Commons Attribution 4.
Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Domestic Violence Martin R. Author Information Authors Martin R. Affiliations 1 University of Louisville. Continuing Education Activity Family and domestic violence is a common problem in the United States, affecting an estimated 10 million people every year; as many as one in four women and one in nine men are victims of domestic violence.
Introduction Family and domestic violence including child abuse, intimate partner abuse, and elder abuse is a common problem in the United States. Intimate partner violence typically includes sexual or physical violence, psychological aggression, and stalking.
This may include former or current intimate partners. Child abuse involves the emotional, sexual, physical, or neglect of a child under 18 by a parent, custodian, or caregiver that results in potential harm, harm, or a threat of harm. Elder abuse is a failure to act or an intentional act by a caregiver that causes or creates a risk of harm to an elder.
Epidemiology Domestic violence is a serious and challenging public health problem. National Most perpetrators and victims do not seek help. Healthcare professionals are usually the first individuals with an opportunity to identify domestic violence. Only one-third of police-identified victims of domestic violence are identified in the emergency department. Healthcare professionals who work in acute care need to maintain a high index of suspicion for domestic violence as supportive family members may, in fact, be abusers.
Pathophysiology There may be some pathologic findings in both the victims and perpetrators of domestic violence. Abusers tend to: Have a higher consumption of alcohol and illicit drugs and assessment should include questions that explore drinking habits and violence.
Be controlling of everyday family activity, including control of finances and social activities. Children who witness domestic violence are at increased risk of dating violence and have a more difficult time with partnerships and parenting. Children who witness domestic violence are at an increased risk for post-traumatic stress disorder, aggressive behavior, anxiety, impaired development, difficulty interacting with peers, academic problems, and they have a higher incidence of substance abuse.
Children who witness and experience domestic violence are at a greater risk for adverse psychosocial outcomes. Abused teens may not report abuse. Individuals 12 to 19 years of age report only about one-third of crimes against them, compared with one-half in older age groups. Domestic violence is more common among pregnant women than preeclampsia and gestational diabetes.
Reproductive abuse may occur and includes impregnating against a partner's wishes by stopping a partner from using birth control. Since most pregnant women receive prenatal care, this is an excellent time to assess for domestic violence. There are more cases of domestic violence among males living with male partners than among males who live with female partners.
Females living with female partners experience less domestic violence than females living with males. Transgender individuals have a higher risk of domestic violence. Transgender victims are approximately two times more likely to experience physical violence. Each year, approximately , women are physically assaulted or raped by an intimate partner compared to , men. Three out of 10 women at some point are stalked, physically assaulted, or raped by an intimate partner, compared to 1 out of every 10 men.
Rape is primarily perpetrated by other men, while women engage in other forms of violence against men. Approximately one-third of nursing homes disclosed at least 1 incident of physical abuse per year. History and Physical The history and physical exam should be tailored to the age of the victim. Child Abuse The most common injuries are fractures, contusions, bruises, and internal bleeding. Intimate Partner Abuse Approximately one-third of women and one-fifth of men will be victims of abuse.
Elderly Abuse Health professionals should ask geriatric patients about abuse, even if signs are absent. Risk Factors Dementia. Pathologic characteristics of perpetrators including dementia, mental illness, and drug and alcohol abuse. Evaluation Establishing that injuries are related to domestic abuse is a challenging task. Clinicians should screen all females for domestic violence and refer females who screen positive.
This includes females who do not have signs or symptoms of abuse. All healthcare facilities should have a plan in place that provides for assessing, screening, and referring patients for intimate partner violence. Protocols should include referral, documentation, and follow-up. Health professionals and administrators should be aware of challenges such as barriers to screening for domestic violence: lack of training, time constraints, the sensitive nature of issues, and a lack of privacy to address the issues.
Although professional and public awareness has increased, many patients and providers are still hesitant to discuss abuse. Patients with signs and symptoms of domestic violence should be evaluated.
The obvious cues are physical: bruises, bites, cuts, broken bones, concussions, burns, knife or gunshot wounds. Typical domestic injury patterns include contusions to the head, face, neck, breast, chest, abdomen, and musculoskeletal injuries. Accidental injuries more commonly involve the extremities of the body. Abuse victims tend to have multiple injuries in various stages of healing, from acute to chronic.
Domestic violence victims may have emotional and psychological issues such as anxiety and depression. Complaints may include backaches, stomachaches, headaches, fatigue, restlessness, decreased appetite, and insomnia.
Women are more likely to experience asthma, irritable bowel syndrome, and diabetes. If there is no immediate danger, the assessment should focus on mental and physical health and establish the history of current or past abuse. These responses determine the appropriate intervention. Source: NZ Herald. Recorded on the first Sunday following the March 29 lockdown, this figure was compared with incidents reported in the three previous Sundays. Sadly, experts acknowledged that it was expected since highly stressful events in the past, like the financial crisis, similarly drove domestic violence stats up.
Source: Global Citizen. A July survey of 15, Australian women revealed that more than one in ten respondents had suffered domestic violence over the past 90 days. Over half of the victims said that the nature of the abuse had intensified, while another one-third confessed that the violence was unprecedented.
These domestic violence statistics in suggest that situational stressors like job insecurity or financial distress have aggravated abusive behaviors. Source: Statista. Compulsory confinement has created a perfect storm for people living with abusive partners. Less access to first responders has made it more difficult to receive help from the government. Source: America Magazine. The authorities have received over , reports related to domestic violence.
Either statistic of domestic violence indicates that Mexican women have been dealing with two crises at once:. The former may be older, but the latter has compounded it. Source: diario The government is aware that increased tensions and economic pressures could exacerbate abusive relationships. To enable victims to seek help with less risk, apps were rolled out to aid the existing domestic violence service helplines.
In hopes of further reducing the prevalence of domestic violence in the country, the abused have also had the option to request assistance through WhatsApp and App since March Normally, two women fall victim to domestic violence every minute, while seven female-targeted murders happen every day on average in the country.
But extraordinary waves of violent crime have engulfed Brazilian communities since social distancing orders were put in place. Source: RPP. It was bad enough that Bolivia has the highest rate of femicide in Latin America, with 2 deaths per , women.
But the overall climate of violence at home even worsened, as the worry over coronavirus contraction, confinement, money, and lack of activity deepened. Source: Middle East Institute. The government claimed that the number of women killed in May 81 was less than the stats on domestic violence recorded in the same period last year.
It contradicted the trend in other countries, where the occurrences of domestic abuse have risen since pandemic-induced lockdowns were enforced. Reports also highlighted that some women were not being given proper protection from violence because of their marital status.
Source: BWSS. Such a rapid rise of probable abusive statistics during the pandemic has exposed the link between home isolation and domestic violence. It indicates that the situation makes it easier for the abuser to control the movement of the abused, keep the latter away from safety networks, and minimize access to support services.
However, there was a sharp drop in complaints directly reported to the police. It suggests that isolation might have made it much trickier to ask for help. After all, the support of loving people around the victim was needed to file a formal complaint about the abuse.
Source: Reuters. These figures might not indicate more amity in Italian households, though. A parliamentary committee was convinced that they likely meant there was a graver prevalence of unreported domestic violence. Government critics say British policymakers have been failing survivors of domestic violence by delaying the establishment of a more robust legal framework that can meaningfully protect victims and sufficiently punish abusers.
Prior to the COVID outbreak, support for specialist domestic abuse services in the country was already eroding. Source: Euronews.
The country already had one of the worst of intimate partner violence prevalence in Europe before the pandemic. And being confined with an abusive person only made it worse. Source: Movendi International.
Additionally, more than three in ten women were also victims of physical abuse while stay-at-home orders were in place. From the time the government imposed COVID measures to the day they were relaxed, incidents of domestic violence were reported. According to the police domestic violence statistics in , this four-month figure almost matched the total number recorded in the country in the entirety of last year.
Source: Xinhua. Eight times out of ten in both categories, men were the assailant. The statistics on domestic violence and sexual exploitation in the territory climbed as anxiety about the pandemic worsened. To make matters worse, the government imposed a hour curfew to curb the spread of the disease. Due to the fear of getting stuck with abusers for extended periods, victims were encouraged to capitalize on the free-movement window to get out of the house and stay in a shelter.
With the way things are going, domestic violence is bound to get worse before it gets better. But at the very least, more of us are now beginning to realize that abuse is just a symptom of a bigger problem.
The general notion of domestic violence is physical assault. Sexual, emotional, verbal, and economic abuse can likewise be considered as domestic violence.
Control, isolation, intimidation, and stalking also fall in the same category. Arguably, some seem more threatening than others.
But all are equally concerning nevertheless. More often than not, women are at the receiving end of acts of domestic violence. One in four women in the U. Female victims most commonly first experience domestic violence between the ages of Almost one out of five or Violence against women occurs predominantly behind closed doors at home with most cases having never been reported to police.
The risk of perpetrating intimate partner violence as an adult is two times greater for those who were abused or witnessed their mother being abused during their own childhood. Likewise, the risk of becoming a victim of domestic violence as a teen or adult is greatly increased when young people are raised in households where abuse is present. While domestic violence happens to people in all walks of life regardless of age, gender, sexual orientation, race, religion, education, profession or socioeconomic status, there are statistical predictive indicators of domestic violence , probably the most important being exposure to it as a child.
Here are a number of excellent sources for additional statistics, infographics and citations to research in each of the following categories:. Make a Donation It is easy to ignore this message. Please don't.
We and the millions of people who use this non-profit website to prevent and escape domestic violence rely on your donations. Please help keep this valuable resource online. Fortunately, there are thousands of programs across the U. The trove of useful information includes state-by-state and national domestic violence shelter budget and spending data and rankings , as well as availability of types of domestic violence shelter services by state and nationally including domestic violence shelter pet services , people served by domestic violence shelters annually , domestic violence shelter funding source data and domestic violence shelter turn-away data.
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