Pediatric Injury

Betsy Johnson MS, CPNP-

PC
Objectives
 Describe the developmental characteristics that predispose infants/children to
injuries and anticipatory guidance strategies to prevent the injuries.
 Describe the methods for assessing a burn wound.
 Discuss the physical and emotional care of a child with a severe burn wound.
• Identify the principles in the emergency treatment of poisoning.
 Name common sources of lead in the environment.
 Describe the nursing care of the child with lead poisoning.
 State three factors thought to be associated with child abuse.
 Describe signs, symptoms, recognition, reporting and care of the abused
child.
 Discuss child abuse, human trafficking, assent vs informed consent in the
care, legal responsibility of mandatory reporting in pediatric patients and
families.
 State four areas of the history that should arouse suspicion of abuse.
 Describe the nursing care of the abused child
Safety in Pediatrics

• Young children are inherently unsafe

• Developmental age needs to be considered
• Require:
• Safe environment
• Responsible adult to provide safety measures
• Emerging sense of safety within to make safe
decisions as they mature
Pediatric Nurse role in Safety

• Safety Role Model

• Teaching safety: Anticipatory Guidance
• Demonstrate safe care across developmental
levels
• Demonstrate safe care for special needs
children
• Safety in the clinical setting
Injuries in Childhood

• Motor Vehicle accidents

• Falls
• Burns
• Suffocation, asphyxiation, or choking
• Drowning/ Near Drowning
• Sports/ recreation Injuries
• Poisoning
Pediatric Ingestions

• Less then 6 years old

• Poison Control Centers receive >
4,000 calls a day for this age
group
• In the home
• Preventable!
• Visitors in the home bringing meds;
visiting others’ homes
• Since the 1960’s deaths from
poisoning have declined from 450
to approx 30 per year
Why children are at higher risk

• Anatomy & physiology

• More food and water consumed relative to body mass
• Skin, blood brain barrier more permeable
• Greater absorption ingested toxins
• Exposure
• Pollutants
• Closer to ground
• Behavior
• Everything goes into mouth when children are small
Prevention
• Poison-proof home
• Locations of poisons
• Locks on cabinets
• Safety containers
• Discard unused medicines
• Supervise children
• Phone number for poison control
• Get down at child’s viewpoint
• Environment changes with visitors: keep meds up high

• Although many take care to “child-proof” their home,

children can easily access the prescription meds of
others
Most Common Culprits:
Non-Pharmaceuticals Pharmaceuticals
• Beauty / Personal Care
Products • Prescription Meds
• Cleaning Products • Recreational Drugs
• Plants • Analgesics
• Poisons (rat, ant, roach • Household Products
& weed killer) Database:
http://householdproducts
• Antifreeze .nlm.nih.gov/index.htm
• Safe cosmetics
database:
http://www.ewg.org/
skindeep/

http://www.ci.roseville.mn.us/fire/FirstPoisoning.html
 Corrosives
Any strong acid or base
(ie. cleaners, detergents, bleach, batteries)
• Common Manifestations:
• Burns - pain, red / white areas, swelling, ulceration
• Drooling, violent emesis
• Specific Considerations:
• Prevent vomiting: can cause burn on the way back up as well, vomiting
can cause aspiration
• May dilute with very small amount of water or milk

• https://youtu.be/fNZPmct4ZzM
 Hydrocarbons

Petroleum products and volatiles

(ie. gas, kerosene, lamp or mineral oil, lighter fluid, paint thinner)
• Common Manifestations:
• Choking, gagging, coughing, vomiting
• Lethargy, weakness, loss of consciousness
• Respiratory distress, chemical pneumonia
• Specific Considerations:
• Do NOT induce vomiting
• Swallowing even a small amount leads to severe respiratory
problems
• Complications often delayed: MUST monitor

http://www.hammertonesa.com/Products/lampoils.htm
 Tylenol: Acetaminophen
An ingredient in many cold medications (i.e. Ny-Quil)
“Overdoses” are also common
• Casual dosing
• Wrong concentrations (infant syrup is 3 x’s conc!)
• Suicide gestures
• Common Manifestations:
• Few symptoms in early stages when most treatable
• Monitor levels 48-72 hours
• Can be exceptionally hepatotoxic
• Specific Considerations:
• Antidote: Mucomyst (N-acetylcysteine) IVPB**** NEED
TO KNOW THIS higher concentrations for first 8 hours,
then 16 more hours  block receptor sites in liver
Aspirin: Acetylsalicylic Acid

Also in many combination OTC’s (i.e. Pepto-bismol)

• Common Manifestations:
• N/V, dehydration, hyperpyrexia, hyperpnea,
tinnitus
• Disorientation, loss of consciousness
• Metabolic acidosis
• Specific Considerations:
• Sodium Bicarbonate used to correct acidosis and aid renal
elimination

www.chrisorbach.com
Iron Toxicity

• Common Manifestations: • Ferrous sulfate (20%

• GI Symptoms - nausea, elemental iron)
abdominal pain,
vomiting & diarrhea • Children's multivitamin
(may also be bloody) with iron preparations
• Fever, hyperglycemia, contain 8 to 18 mg of
bleeding, metabolic elemental iron per
acidosis
chewable tablet
• Specific Considerations:
• Chelation Therapy - • Prenatal vitamin, which
used to remove iron has 325 mg ferrous
(considered a “heavy sulfate (65 mg elemental
metal”) from the body iron) per tablet.
Iron Toxicity

• A serum iron level should be obtained on arrival to the emergency department

if the patient is symptomatic or has ingested >60 mg/kg of elemental iron.
• A patient who has ingested less than 20 mg/kg of elemental iron and is
asymptomatic can be observed.
• For patients with serious iron ingestion, treatment should include gastric
decontamination, intensive supportive therapy, and deferoxamine
administration/chelation therapy.
• Gastric lavage should be done for patients with a large ingestion or if they are
symptomatic. Whole bowel irrigation (WBI) is recommended if there are iron
pills seen on X-ray and for any significant ingestion.

•  
 Summary
Poison Cl. Manif. Treatment Comments
Corrosives Burning in mouth, Liquid corrosives
Do not induce
edema of lips, worse than
vomiting,
vomiting, drooling granules
steroids, dilute
corrosive
Hydrocarbons Gagging, choking, Do not induce Aspiration can
coughing. vomiting cause pneumonia
Lethargy

Acetaminophen N & V. Hepatic Antidote is Most common,

involvement Mucomyst toxic dose is 150
mg/kg
Aspirin Nausea, Emesis, c
disorientation, activated
coma, convulsions charcoal
Vomiting & Gastric lavage,
Iron Resembles candy
Diarrhea chelation therapy
Initial Emergency Room Care 30
• Assess
• Complete assessment of the initial “event”  check ABCs first
• Vitals, breathing, perfusion
• Level of consciousness & mental status
• Complications/ Risk
• Terminate Obvious Exposure
• Identify poison
• Prevent poison absorption
• Evaluate the Situation
• How can repeat episode be prevented?

• Contact Poison Control in all cases!

Poison Control
information

Home if child stable or in ED- call to

National Poison Control Center with
this information:
• What was swallowed
• Child’s weight, age, and how
long ago poisoning occurred
• Route of poisoning (oral,
inhaled, sprayed on skin)
• Estimation of how much poison
taken
• Child’s present condition
(sleepy, hyperactive, comatose)
Advanced Emergency Care
Activated Charcoal - preferred in most cases
Must be given ASAP to be effective
Neither gritty nor distasteful, but resembles black mud
May be given mixed with diet soda through straw in opaque glass with cover
or by NG tube

Gastric Lavage
May be contraindicated depending on risk for aspiration
Tube in stomach, putting fluid in, pulling it back out

Cathartics - increases gastric motility (i.e. sorbitol)

Many charcoal preps are premixed with sorbitol
May lead to dehydration
Antidotes Syrup of ipecac (emetic) –
Toxin specific no longer recommend
Narcan, Mucomyst for immediate treatment of
poisoning
Lead Pediatric Context…

• Greater risk for exposure

• Hand-to-mouth tendencies
• Inner cities
• Older homes

• Absorb lead more readily than adults

• Greater risk for serious impairments
• Impact on behavior, learning & growth

• Especially vulnerable populations:

• Children < 6 yrs old, minorities & lower income populations

http://www.carolynsandstrom.com/album_seven.htm
 Pathophysiology

• Can be absorbed by inhalation or ingestion: lead dust

• If remediation is being done for lead (on a house), children should
not be living in the house
• Very small fraction circulates in blood (~5%)
• Remainder is stored in organs
• Mostly deposited in skeletal and nervous systems: brain, bone,
kidneys
• Damages renal tubules as it is excreted
• Early detection and treatment is key to preventing
irreversible damage
Lead distribution

• Enters blood stream, with 99% bound to erythrocytes

• Competes with calcium for storage sites
• 75-90% stored in bone, teeth
• 10-25% stored in soft tissue
• Liver
• Kidney
• Bone marrow
• Brain
• If not stored as above, excreted in bile and urine
• Half-life in blood 10 months
• Half-life in bone 20 years
Culprits (Contact may be indirect)

• Paint
• Water supply, older pipes (Flint, Michigan)
• Occupational
• Hobbies
• Imported or home-made goods
• Antique toys and furniture
• Some multi-cultural foods & folk remedies
Manifestations & Complications

• Neuro-behavioral:
• Conduct disorders
• Irritability, aggression &
hyperactivity
• Learning disabilities
• Lower IQ achievement
• Sleep disturbances
• Speech delays
• Delayed puberty
• Hearing problems

http://www.detmir.ru/cntnt/o_detyah/zdoroviy_duh/problemi_vospitaniya.html http://www.psychiatry.emory.edu/PROGRAMS/GADrug/Edfas.htm
Manifestations & Complications(cont…)


effect of lead on
• Hematologic: RBC’s
• Anemia
• Iron deficiency
• Other:
• Renal / Hepatic toxicity
• Nausea, vomiting, abdominal pain & anorexia
• Rashes

http://www.mja.com.au/public/issues/177_04_190802/tai10010_fm.html
Screening

• Assess for targeted risk factors

• Routine capillary testing

Blood Lead Level (BLL) - in g/dl

< 10 -- Acceptable (but want to see 0)
10 - 44 -- Mild to moderate toxicity
45 - 69 -- Severe toxicity
> 69 -- Medical emergency
Chelation Therapy

• Removal from circulation

• EDTA (Increased fluids needed, IV or IM)
• BAL (not for peanut allergy/ hepatic
insufficiency, deep IM only)
• DMSA (level 45-69 and asymptomatic, PO)

Iron therapy after treatment complete (for

anemia)

• Rebound Toxicity
• Multiple chelation tx may be needed
Interventions for Prevention

• Home renovation : Not with children

in house

• Cleaning of surfaces : Wipe down with

wet cloths

• Transmission

• Exposure clean-up
Ingestion Recurrence Prevention 30

• Challenge of
supervision
• Contributing factors
• Home assessment for
hazards
• Poison proof home
 Burn Facts

• 250,000 Children in the U.S. (AGES 0-17) are seriously burned each year
• 15,000 are hospitalized
• 1,100 die from burn injuries
• 20% of all peds burns are intentional
• Sources:
• Scalds: esp with younger children
• Contact with hot object
• Fireworks, gasoline, cigarettes
• Fire: school age are fascinated by fire
• Greatest risk – age range

• Relationship to abuse
 Burn Prevention
• Scalding
• Keep hot water heater temperature lower than 120°F.
• Test bath water temperature before bathing children.
• Cook with pots on the inside of the stove with the handles turned in, Keep
children away from the stove while cooking.
• Place hot liquids out of reach of children.
• Avoid drinking hot beverages while holding a child.
• Contact burn:
• Keep children away from open flames, stoves, and candles.
• Keep curling irons / hot objects out of reach of children.
• Teach older children how to safely get out of the house in case of fire.
• Practice fire drills.
• Teach children to “stop, drop, and roll” if their clothes catch on fire.
Assessing Severity
of Burn

• Percentage of body
injured (>10% =
Hospitalization)
• Adult Rule of nine
not effective
measure
• Depth of burn
• Location burn
• Cause of burn
• Age of child
• Presence of concurrent
illness
Estimating Burns- Pediatric
Modifications

All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of
Elsevier Inc.
Burn Depth 35
Older Terms Recent Terms
 Burn Depth 36

• Superficial
Thickness
(epidermal layer)
 Dry, red, blanches and
refills with pressure
 Minimal or no edema
 Painful, sensitive to
touch
 - Usually heals well
Partial Thickness

Epidermis & dermis involved

Very painful
Blistering present
Photo credit: http://www.vicburns.org.au/burns-assessment/burn-depth/mid-dermal-parial-thickness-
burns.html
Full Thickness

Epidermis and dermis destroyed

Extends to at least the subcutaneous tissues, if not fascia,
muscle, and bones.
May have hard leathery tissue which impedes circulation,
expansion (Eschar)
May be painless at first becoming more painful as nerves
regenerate
Requires grafting: long healing process
Scarring occurs
Burn Location

Areas of particular
concern:
• Face
• Hands/feet
• Genitals
• Circumferential
burns
Pathophysiology of Thermal
Injuries

• Systemic response involving capillary permeability

(happens quickly, 20-30 min after burn of about 5-7% of
BSA)
•Edema
•Anemia
•Electrolyte shift
•Hypovolemia/Fluid loss
•Shock and airway compromise  biggest complications within 24
hours of burn
Complications
• Airway compromise
• Sepsis
 Minor Burn
Emergency Care Ongoing care

 Stop burn process • Care within 24 hrs

 Leave blisters unless • Wound cleansing
chemical • Debridement
 No ointment on burn
 Cover burn/ clean • Dressings
dressing • Tetanus
• Pain control
• Monitor for
function/ infection
Immediate Care-Major Burn

• Stop burn process!!

• Remove burned clothing/jewelry
• Consider ABC’s/ CPR
• Secondary injuries
• Cover burn: clean, dry dressing
• Light cover to keep patient warm
• May intubate in the field if there is
concern for respiratory compromise
• Initial TX- IV, O2
• Transport
Major Burns: Emergent Management
First 24-48 hours Stabilize

Therapeutic Nursing

• First priority is • Vital signs, NPO

airway • I/ O’s, electrolytes
• Burn shock: Fluid • Assess
replacement
• Respiratory
• Circulation • Circulation
• Medications • Neurological
• IV’s (2 lines) • Thermoregulation
• Pain
• Support child/family
Promote Oxygenation & ventilation
44

• Injuries to face, nares & upper torso or inhalation of

noxious agents
• Airway edema up to 2 days after burn!
• administer 100% O2
• check blood gas values & CO levels
• insert ET tube early and secure
• Bronchodilators, semi-Fowler’s position
 Fluid Loss in Burns
45

• Skin protects fluid and electrolyte loss.

• Burns change the distribution of fluid in the body.
• Various inflammatory mediators are released from burn
sites.
ex. Histamine, prostaglandins, leukotrienes.
• ↑permeability of capillaries.
• Protein and fluid are lost into the interstitial
space→causes edema.
• Leads to BURN SHOCK!!
Fluid management is critical in the burn patient!!
Fluids: Parkland Formula
• Used to determine the amount of resuscitation fluid
46
necessary in the first 24 hours.
• 4ml (LR)x Body Weight (kg) x TBSA Burned
• Ex. 4ml x 9.75kg x 15%= 585ml/24hr.
• First Half of LR is given in initial 8 hours from the time of the burn.
• Second Half of LR is given over the remaining 16 hours.
• Calculation of Maintenance fluid
• 0-10kg: 4ml/kg/hr
• 11-20kg: 2ml/kg/hr
• >20kg: Plus 1ml/kg for each kg
• Ex.4ml D5LR x 9.75=39ml/hr (936ml/24hr)
• Calculate Parkland formula from the time of the burn.
• Monitor UOP and SG to determine adequacy of hydration
• Minimum urinary output
• Infants: > 2 mL/kg of body weight/hr
• Children: 1 mL/kg of body weight/hr
Major Burns: Acute Phase:
48 hours to wound closure
Therapeutic Nursing

• Fluid/ Electrolyte • Feeding tolerance

• Nutrition: calorie  • Monitor for infection
might need NG for (Isolation ?)
supplementation • I/O’s
• Debridement • Thermoregulation (warm
• Grafting and humidified room)
• Medications • Comfort management
• Reduce scar • Wound Care
formation and • Monitor for complications
prevent contractures
 Comfort 48

•All burn victims experience pain!

•Healing wounds cause pruritis- Control as well
• Pharmacological Treatment 
• Mild burns: oral medication such as narcotics or NSAIDS. 
• Severe burns: IV narcotics.
• PCA for 7 year of age or older= better pain management. 
• As pain becomes better controlled, oral medications such as
slow release morphine are used. 
• Medicate before: Debridement, dressing changes, and
physiotherapy 
• Control itching- antihistamines
Non-pharmacological Treatment 
• Imagery, distraction, deep breathing & relaxation
Infection Prevention

 Blisters provide a good culture for

bacteria to grow 
 Vaccines, sterile technique,
nutrition
 Sepsis due to immunosuppression 
 Most susceptible in the first 10
days after sustaining a burn trauma

Topical Antimicrobial Agents

 Bacitracin
 Silver Sulfadiazine: decreases bacterial
colonization
 Sulfamylon
Gauze infused with antimicrobials 49
 Wound Care
• Remove blisters, clean the wound, debride dead tissue, and
daily dressing changes. Healing skin sticks to itself- no two
burn sites touching
• Antimicrobials, keep eschar soft
• Physical therapy (exercises) and occupational therapy
(splinting) to prevent contractures – particularly to joints
where there are burn wounds
• Pressure dressings/garments
• Grafting
• Protect from trauma & infection
• Assess for signs of infection or lifting
• Optimize nutrition
Compartment Syndrome 51

• Escharotomy

• Fasciotomy
 Nutrition
52

• Hypermetabolism
• caloric requirements are 3-5 times normal!
• high-protein, high-calorie diet

• May be large protein losses due to albumin

seepage

• Poor appetite – require tube or enteral feeding

 Rehabilitation/Long-term Complications
53

• Contractures
• PT/OT, splinting
• Scarring
• Compression garments, massage
• Disfigurement & disability
• Reconstructive surgeries
• Benjamine
Rehabilitation after Major Burns

• Multidisciplinary
• Prevention of complications
• Psychosocial and social concerns
• Child
• Pain
• PTSD: the burn itself and the care following the burn
• Body Image
• Parent
• Guilt
• PTSD
All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of
Elsevier Inc.
Non-accidental Burns:
Child maltreatment Indicators

• Does the injury match the story and

developmental level?
• Submersion burns
• Burns on face, back, hands, legs or butt
• Patterned, symmetrical or repetitive burns
• Cigarette burns
Child Maltreatment

• Term includes neglect, emotional abuse, intentional

physical abuse, and/or sexual abuse of children
• Highest rates in 0-3 year old group
• Usually by adults
• Neglect most common
• Significant social problem

• Statistics
https://www.childhelp.org/child-abuse-statistics/
07/04/2020
Incidence (2013 Data)
• CPS: received 3.5 million referrals ( 6.4 million children)
• CPS determined that 61% needed further action to protect.(2.1
million)
• The national rate of victimization: 9.1 per 1,000
• 3/5 of reports of alleged child maltreatment are made by
professionals
• Children < 4 had the highest rate of victimization (33.4%)
• An estimated 1,520 children died as a result of child maltreatment
• Greatest percentages of children suffered from neglect (79.5%) and
physical abuse (18.0%).
• 78.9% of child fatalities were caused by one or both parents.
• 83.0% of perpetrators were between the ages of 18 and 44 years.
More than one-half (53.9%) of perpetrators were women
07/04/2020
Neglect usually results from a combination of factors: poor
parenting, poverty, poor parental coping skills, mental illness,
substance abuse, financial & environmental stresses

• Physical neglect
• Deprivation of food, clothing, shelter, supervision,
medical care, education.
• Emotional neglect
• Lack of affection, attention, and emotional
nurturance
• Emotional abuse
• Destroys or impairs child’s self-esteem
 Physical Abuse

• Deliberate infliction of physical injury on a child

• States define abuse according to individual reporting
laws (non-universal)
• Signs & Symptoms
:
• Skin lesions: Handprints, ecchymosis, multiple small burns,
symmetric scald burns, bite marks, thickened corner of mouth,
alopecia from having hair pulled
• Fractures: rib, vertebral, long bone and digit fractures in non-
ambulatory children  spiral fracture, multiple fractures in
different stages of healing, skull fractures
• CNS injuries: abusive head trauma, fussy, vomiting, retinal
hemorrhages, stuporous or coma
• Children are often fearful, irritable and sleep poorly, have
depression and anxiety, some post traumatic stress reactions
and may have violet or suicidal behavior; might not have
normal reaction to pain – very stoic
07/04/2020
Factors Predisposing to Physical Abuse

• Parental characteristics
• Age, single parent, unrelated partner
• Low self-esteem, poor parenting
knowledge, poor role model
• Characteristics of the child
• Age from newborn to 1 year
• Physically disabled, hyperactive,
premature
• Environmental characteristics
• Social isolation, poor support systems
• Chronic stress, poverty, substitute
caregivers
• Discipline vs abuse (right from wrong
vs living in fear)
 Shaken Baby Syndrome
62

• Usually in response to caregiver overwhelming

frustration & stress
• Typical report is that child was found sleepy or not
breathing
• Findings:
• Retinal hemorrhages
• Subdural hemorrhages
• concurrent fractures
• Outcome: high risk for death or permanent
disability
• http://www.youtube.com/watch?v=EpgBEIV-VBs&fe
ature=related
Sexual Abuse 63

Acts Characteristics

• Rape or molestation • Abuser

• Prostitution • Victim
• Incest with children • Initiation &
• Exhibitionism Perpetuation
• Child pornography or
prostitution
• Pedophilia
All Elsevier items and derived items © 2013, 2009, Mosby, Inc., an imprint of
Elsevier Inc.
 Sexual Abuse
• Children do not Physical signs
spontaneously disclose sexual
abuse o Difficulty in walking or
sitting
• Most disclose is delayed, days
to years o Bruises or tears around
the genitals, anus &
• Abrupt or extreme changes in mouth or healed
behavior can occur lesions
• Aggressiveness or withdrawal o Vaginal discharge,
• Phobias and sleep bleeding or pruritus
disturbances may occur o STD or pregnancy
• May act in ways that are
sexually inappropriate for
their age
Human
Trafficking
Sex trafficking: the recruitment, harboring,
transportation, provision, or obtaining of a person
for the purpose of a commercial sex act, in which
the commercial sex act is induced by force, fraud,
or coercion. Or in which the person induced to
perform such act has not attained 18 years of age
Labor trafficking: the recruitment, harboring,
transportation, provision, or obtaining of a person
for labor or services through the use of force,
fraud, or coercion for the purpose of subjection
to involuntary servitude, peonage, debt bondage,
or slavery
Human trafficking video
Human trafficing

Risk Factors Symptoms

• Runaways • Signs of abuse
• Male/Female/transge • Social isolation
nder • STD’s
• Foster care system
• History of sexual
abuse
• Gang involvement
If you suspect Human trafficking
 The child at risk

• First time parents, teenage parents and parents with

several children < 5 years old
• “The difficult child”
• Poor parent/child goodness-of-fit
• Premature infants
• Difficult pregnancy or labor
• Disabled or delayed children
• Colicky babies
• Toddlers
• The toilet training child
• Parents who were abused
Nursing Care of the Maltreated Child
• Identify abusive situations as early as possible
• Detailed history and thorough physical examination
pertaining to the incident
• Evidence of maltreatment
• Pattern or combination of indicators that arouse suspicion
and further investigation: ER hopping, multiple visits
• Child and caregiver histories of events do not match
• Inconsistent or incongruent behaviors
• Address urgent medical needs and child’s immediate safety
• Support the family
 Warning Signs of Abuse

• Physical evidence & previous injuries

• Conflicting stories or changes with retelling
• Cause of injury blamed on sibling or other
party
• History inconsistent with child's
developmental level or injury
• Inappropriate response of child or
caregiver
• Child's report of physical or sexual abuse
• Previous reports of abuse in the family
• Repeated ER visits

70
Reporting: Not just a moral obligation… 71

• Federal law:
• Mandates immediate reporting of cases by Health Care
Providers to Child Protective Services (CPS) where abuse
or neglect is suspected. Every state has its own laws
• Failure may result in jail time, fines, license removal
• Protection of the “good faith” reporter
• Maryland law:
• Oral report
• Written report You are a mandated reporter:
• Health Practitioner
• Educator
• Human Service Worker
• Police Officer
Determination of Harm
• Biggest concern: keeping child safe from harm
• Removal from home
• Protective hospitalization
• Placement with relatives or in temporary housing
(sometimes a whole family is moved out of an
abusive partner’s home)
• Going home with prompt social service and
medical follow-up (especially neglect)
• Temporary foster care
• Safest disposition for the child
• The Tree House