Pediatric Boot Camp Series: Infant With Altered Mental Status and Seizure—A Case of Child Abuse

Publication ID Published Volume
10552 March 10, 2017 13

Download the Educational Summary Report

Abstract

Introduction: Child abuse, also known as nonaccidental trauma (NAT), is an important cause of pediatric morbidity and mortality. The presentation of NAT is often confounded by unclear histories and victims who are unable to provide information. Medical students and trainees may fail to consider NAT as a diagnosis or be unfamiliar with the evaluation process. Methods: This curriculum uses simulation, small-group discussion, and didactics to help medical students gain an understanding of presentation of NAT. Using the case of a 2-month-old boy presenting with altered mental status and seizure, participants practice the assessment and management of an acutely ill patient. Small-group discussions facilitate schema building to enhance each participant’s ability to recognize and diagnose different diseases that may present as infant seizure and to identify the signs of NAT. Didactics solidify concepts addressed during the simulation and small-group discussions. Results: Medical students participating in this course reported that they felt better prepared for their internships and that working through a case with a large differential diagnosis was helpful for their understanding of causes of infant seizures, including abusive head trauma. Discussion: This curriculum is unique in that it uses one unifying case to allow participants to demonstrate an understanding of the evaluation and stabilization of a critically ill pediatric patient, develop a broad differential diagnosis for a nonspecific symptom, and prioritize and evaluate possible etiologies through the gathering and interpretation of data. This curriculum may be used independently or in conjunction with other learning activities as part of a pediatric boot camp.

Citation

Metz J, Stone K, Reid J, Burns R. Pediatric boot camp series: infant with altered mental status and seizure—a case of child abuse. MedEdPORTAL Publications. 2017;13:10552. https://doi.org/10.15766/mep_2374-8265.10552

Educational Objectives

After participation in this simulation and case conference, participants will be able to:

  1. Formulate a differential diagnosis for an infant with altered mental status and seizure.
  2. Perform medical stabilization of an infant with altered mental status and seizure.
  3. Identify physical exam, laboratory, and radiologic findings concerning nonaccidental trauma.

Keywords

  • Pediatrics, Nonaccidental Trauma, Battered Child Syndrome, Abuse, Simulation, Seizure

References

  1. Abend NS, Loddenkemper T. Pediatric status epilepticus management. Curr Opin Pediatr. 2014;26(6):668-674. https://doi.org/10.1097/MOP.0000000000000154
  2. Bensadoun E, Dolan T. Chest radiology tutorial. MedEdPORTAL Publications. 2007;3:796. http://dx.doi.org/10.15766/mep_2374-8265.796
  3. Burns R, Mangold K, Adler M, Trainor J. Pediatric boot camp series: obtaining a consult, discussing difficult news. MedEdPORTAL Publications. 2016;12:10437. http://dx.doi.org/10.15766/mep_2374-8265.10437
  4. Burns R, Nicholson A, Mangold K, Adler M, Trainor J. Pediatric boot camp series: assessment and plans, task prioritization, answering pages, handoffs. MedEdPORTAL Publications. 2015;11:10310. http://dx.doi.org/10.15766/mep_2374-8265.10310
  5. Childhood acute lymphoblastic leukemia treatment (PDQ)–health professional version. National Cancer Institute Web site. https://www.cancer.gov/types/leukemia/hp/child-all-treatment-pdq. Updated October 12, 2016. Accessed October 28, 2016.
  6. Christian CW; Committee on Child Abuse and Neglect. The evaluation of suspected child physical abuse. Pediatrics. 2015;135(5):e1337-e1354. https://doi.org/10.1542/peds.2015-0356
  7. Farah MM, Tay K-Y, Lavelle J. A general approach to ill and injured children. In: Shaw KN, Bachur RG, eds. Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine. 7th ed. Philadelphia, PA: Wolters Kluwer; 2016:1-8.
  8. Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. JAMA. 1999;282(7):621-626. https://doi.org/10.1001/jama.281.7.621
  9. Kimia AA, Chiang VW. Seizures. In: Shaw KN, Bachur RG, eds. Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine. 7th ed. Philadelphia, PA: Wolters Kluwer; 2016:465-471.
  10. Luks A, Takasugi J. A primer on reading chest radiographs. MedEdPORTAL Publications. 2010;6:8004. http://dx.doi.org/10.15766/mep_2374-8265.8004
  11. Smith M, Noeller T. I take care of my kids. MedEdPORTAL Publications. 2011;7:8302. http://dx.doi.org/10.15766/mep_2374-8265.8302
  12. U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Child Maltreatment 2014. US Department of Health & Human Services Web site. http://www.acf.hhs.gov/cb/resource/child-maltreatment-2014. Published 2016.

Material Access

Please sign in to access this material.

Please register for an AAMC account if you do not have one.

Register

Associated Content

  • Contact Us

Subscribe to Our Quarterly Newsletter

Receive featured content & announcements!

ISSN 2374-8265