CCP Child Abuse Recognition and Mandated Reporting 2 — Questions and Answers
Question 1: Under the TEN-4 bruising guideline, bruises in which body areas of a child under age 4 should raise concern for abuse?
- Knees, hips, and nose
- Torso, ears, and neck (Correct answer)
- Shins, knees, and forehead
- Elbows, palms, and chin
Correct answer: Torso, ears, and neck
TEN-4 flags bruising on the torso, ears, or neck in children under 4, and any bruise in an infant under 4 months, because these areas are rarely injured accidentally.
Question 2: A 3-month-old infant who cannot yet roll over arrives with a bruise on the cheek. What is the most appropriate interpretation?
- It is likely from normal crawling
- Any bruise on a non-mobile infant is a red flag that warrants concern (Correct answer)
- It can be ignored unless the parent seems nervous
- It is typical teething-related irritation
Correct answer: Any bruise on a non-mobile infant is a red flag that warrants concern
Infants who are not yet mobile rarely bruise accidentally, so any bruise is a significant warning sign.
Question 3: A burn with a sharp line of demarcation around both feet in a sock-like pattern most strongly suggests:
- Forced immersion in hot water (Correct answer)
- An accidental spill of hot liquid
- A sunburn from outdoor play
- A contact burn from a radiator
Correct answer: Forced immersion in hot water
Stocking or glove burns with clear edges and no splash marks indicate the limb was held in hot water.
Question 4: Which set of symptoms in an infant with no visible injuries could indicate abusive head trauma (shaken baby syndrome)?
- Diaper rash and loose stools
- Increased appetite and long naps after play
- Rash, runny nose, and mild cough
- Extreme irritability, vomiting, lethargy, or seizures (Correct answer)
Correct answer: Extreme irritability, vomiting, lethargy, or seizures
Abusive head trauma often presents with neurological signs like vomiting, lethargy, poor feeding, or seizures without external marks.
Question 5: A staff member notices blue-gray flat marks on a new infant's lower back during the first diaper change. What is the best action?
- Photograph the marks and post them to the staff group chat
- File an immediate abuse report
- Document the marks at enrollment and discuss with the parent, as they may be congenital birthmarks (Correct answer)
- Ignore them and never mention them
Correct answer: Document the marks at enrollment and discuss with the parent, as they may be congenital birthmarks
Congenital dermal melanocytosis (formerly Mongolian spots) can look like bruises, so documenting them at enrollment prevents misinterpretation.
Question 6: Which injury is MOST consistent with a typical accident in a toddler who is learning to walk?
- Loop-shaped marks on the back
- Small round burns on the palms
- Bruises on both upper arms in a grip pattern
- A bruise on the forehead and scraped knees (Correct answer)
Correct answer: A bruise on the forehead and scraped knees
Bony prominences like the forehead, knees, and shins are common sites of accidental injury in new walkers.
Question 7: Parallel loop-shaped marks on a child's back or legs most likely indicate being struck with:
- A doubled-over cord or belt (Correct answer)
- A closed fist
- A wooden block
- An open hand
Correct answer: A doubled-over cord or belt
Patterned injuries often mirror the object used, and looped marks match a folded cord or belt.
