4.5 Child Abuse

Question 1

Types of Child Abuse, Neglect, Violence

Answer 1

NAT (Non-accidental Trauma)
- Physical abuse/neglect - Anytime hands are laid on a child and injury occurs
- Emotional abuse/neglect - Not meeting emotional needs of children (minimizing feelings of self worth, threatening/humiliating a child)
- Verbal abuse
- Sexual abuse - Inappropriate touching, rape, child pornography, molestation

Neglect - Failure to provide care. Failing to provide physical, emotional, and educational needs

Risk Factors
- Infants are at greatest risk
- Children with physical disabilities
- Child is a product of an unwanted pregnancy
- Presence of Poverty
- Unrelated male caregiver in child’s life
- If parent’s were abused as children, they are more likely to be an abuser themselves
- Substance abuse

MALTREATMENT
- Most often due to family violence
- Fatalities occur at higher rates in younger age groups

Question 2

Abuse vs Neglect

Answer 2

Abuse - Involves an act of commission, actively doing something to a child physically, emotionally, or sexually

Neglect - Act of omission, NOT providing adequate nutrition, emotional contact, or necessary physical care

ESSENTIAL
- We as nurses are considered mandatory reporters. If we suspect child abuse or neglect, we are mandated to report that suspicion of abuse to either authority at workplace or directly to child protective services.

Question 3

Child Abuse Etiology

Answer 3

• Most common abuser of a child is parent/guardian or male friend of child’s mother
• Substance abuse is a major contributor (about 50% of cases)

Other Risks
- Drugs/Alcohol
- Poor impulse control
- Poor parenting experiences
- Being abused as a child
- Marital stressors (domestic violence, non-supportive relationships
- Environmental stressors (financial stress, monetary stress)
- Social isolation (people who have few friends or limited help)

Question 4

Signs of Abuse (Infants and Toddlers)

Answer 4

• Most common sign is inconsistency with stories of injuries

Infant - Bruising <6 months old is concerning (if your not old enough to cruise, your not old enough to bruise)

Fracture on any infant <12 months old. If the infant isn’t able to walk or fall down then they should not have fractures.

Shaken Baby Syndrome - Parent’s get frustrated that they shake the baby.
- Intracranial Hemorrhage (increased head circumference - HC)
- Respiratory Distress (broken ribs)
- Bulging Fontanels
- Retinal Hemorrhage (No external physical signs)

Question 5

Signs of Abuse Preschool and Adolescents

Answer 5

• Bruising on abdomen/back/buttocks
• Pattern Bruising (bruise looks like an item such as a fist or bat)
• Bruising at multiple stage of healing (VERY COMMON SIGN OF ABUSE)
• Stocking like burns
• Unusual fractures or multiple fractures at different stages of healing
• Poor eye contact with parents
• Parent does not allow children to speak
• Do stories match up?