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Generally, emergency service is preferred instead of child service. The reason for bringing it is that the child’s condition is very bad and the parents who are afraid of this are obliged to bring the child. Therefore, not only the people who brought it, but also the child should be asked to tell the event, if he is old enough to speak. Anamnesis, together with physical findings, is the best source to inform the doctor. Sometimes, if the physical findings are not obvious enough, only the anamnesis and the attitudes of the people who bring the child are informative. Anamnesis is very important as it can be used as legal evidence in advanced stages. Usually the child is the only witness. At that age, confabulation, that is because children have a wide imagination, telling as if there is something that does not exist, making up stories is very common, and what children tell and say to their parents, relatives or school teachers or during the anamnesis may cause suspicion. However, in cases of abuse, it is observed that children generally prefer to remain silent rather than speak, and in some cases they later deny what they said.
One of the features that should be considered while taking an anamnesis from the child is the type of the questions. It is important that the questions are not leading. Questions should be short, clear and understandable. For example “What happened? What else? Short questions such as “Did anything else happen?” And the participation of a second adult in the interview are also a positive factor. In addition, it is of great importance that the questions are recorded in writing during the anamnesis.
In practice, it is observed that the anamnesis is taken from the parent or caregiver of the child. In the vast majority of cases, secret agreements are made in the statements to be given, in order to protect each other, generally. Therefore, the anamnesis to be taken separately from the parents at different times is of great importance.
1. 1. 1. 1. 1. Being late in seeking medical help (Sometimes parents may not consult a doctor at all).
2. 2. 2. 2. 2. The accident story is an unrealistic story that lacks details and changes from person to person or from time to time.
4. 4. 4. 4. 4. Suspicious attitude of the parents (They mostly think of themselves – Ask questions such as when will we go).
7. 7. 7. 7. 7. Explanations made by the child. A private interview in an environment where the child feels safe is very helpful for diagnosis.
Physical examination in physical abuse cases: The most common form of physical abuse in a child is beating. It is seen that it is generally applied for discipline and punishment. Physical abuse has been observed in a wide spectrum, from slap to tool use. Therefore, it is not always easy to detect the findings on examination in cases of physical abuse. Clinical findings vary widely. Especially the skin, skeletal system or central nervous system are affected. But it should not be forgotten that other organs may also be affected.
Physical abuse injuries: Skin injuries are the most common and easily recognized lesions in an abused child. Skin injuries from superficial injuries such as 1st degree burns and abrasions, cuts and 2.-3. They give a variable appearance up to serious injuries such as degree burns. Ecchymoses are very important in terms of being the best finding showing the trauma applied to the child and providing information about the event with its localization, shape and color.