Abuse & Violence in the Family Flashcards
Massachusetts Department of Child & Family Services
“1 in 10 children will be the victim of sexual abuse before the age of 18”
Children’s Advocacy Center - Bristol County
Our Mission
> The Children’s Advocacy Center of Bristol County works to empower children and families to heal from the trauma of abuse and violence through community partnerships, education, and the pursuit of justice
Mandated Reporters
ANY healthcare person in care, examination, or treatment of a person
- Nurses, physicians, dentists, podiatrists, psychiatrists
- Public and private school teachers, guidance counselors
- Childcare workers, day care
- Foster parents
- Firefighters, police officers, probation/parole officers
- Clergy members
- Drug/alcohol counselors, social workers
- The child advocate
Childhood Physical & Emotional Abuse
* Emotional abuse
* Physical abuse
> Increases during times of hardship or emotional stress such as during COVID-19
* Sexual exploitation or molestation
All suspected child abuse must be reported to the appropriate authorities
Childhood Physical & Emotional Abuse & Child Neglect
Etiology
- Family dysfunction
- Perpetrator alcohol or drug abuser
- Domestic abuse
- Child disability
- Increased in periods of economic hardship or external stress - like with covid-19 lockdown
- Sexual abuse - perpetrator is usually a family friend or neighbor, males with mental health issues and who were abused themselves during childhood or adolescence
Physical Manifestations
* Bruises in various states of healing
* Bite marks
* Burns (on the back and palms of hands)
* Skeletal injuries such as multiple bone fractures
* Unwillingness to explain injuries
* Child may resist going home from school
* Inconsistent stories regarding injuries
Emotional Manifestations
* Delay in physical and emotional development
* Behavior extremes (overly aggressive or overly compliant)
* Repetitive habits such as headbanging, rocking, biting, sucking
Child Neglect
* Deliberate failure to provide for a child’s needs
- Inadequate weight gain
- Failure to thrive
- Poor growth pattern
- Inappropriately dressed for weather
- Inadequate hygiene
- Lacking routine healthcare such as immunizations
- Truancy
- Home alone for long periods of time unsupervised
Child Sexual Abuse
- Difficulty in sitting and walking
- Complain of pain on urination or in genital area
- Frequent bladder infections
- Bruising or laceration of perineal tissue
- Diagnosis of STD
- Regression with toilet training and increased urinary accidents
- Nightmares or sleep disturbances
- Decreased appetite
- Sudden refusal to participate in gym or other physical activities
- Overt aggression towards others
- Self-destructive behaviors
- Use of sexual language inappropriate for age
Other Specific Abuse Situations
__ __ __
- Also known as shaken baby syndrome or shaken infant
- Caused by vigorous shaking of the baby while being held by extremities or shoulders
- Results in whiplash-induced intracranial and retinal bleeding, skull fractures, altered neurological status, apnea, head or neck bruises, subdural hematoma, and seizures
- Most common trigger for severe shaking is ___
Abusive head trauma (AHT)
crying
Factitious disorder by proxy (medical child abuse)
> Formerly known as Munchausen syndrome
> A psychiatric disorder where a caretaker falsifies illness in the child to gain attention
> Under other adult care child exhibits no symptoms
> This requires removal of child from parent’s care and psychiatric treatment for the parent
Characteristics of Abusive Families
* Isolated from community
* Intense competition for emotional resources
* Lack of a support system
* Exhibit low levels of trust
* Resolve conflict through aggression
* Assume fixed and traditional roles
* Establish rigid rules
Nursing Care
* Obtain a thorough history
> Frequent injuries or signs of healed injuries
* Examine skin for impaired integrity or bruising
> Scalp, bottoms of hands and feet, front and back of the trunk, and genitalia
* Obtain baseline height and weight (to monitor weight loss)
* Assess child’s anxiety level
> Acknowledge child’s fear
> Record child comments verbatim
> Encourage child self-care decisions
* Assess family support system
> Observe interactions between family and child
> Use non-threatening, non-judgemental manner when interacting with family
* Use appropriate assessment tool to identify sexual abuse
* Assist in removing children from unsafe environment
Report any suspected abuse
Substance Abuse
A Healthy People 2030 goal is to increase abstinence in pregnant women from alcohol use, tobacco use, and use of illicit drugs
Diagnosis and management
* Assess throughout pregnancy
> STIs
> Hepatitis
> Exposure to HIV
* Toxicology screening
* Ultrasonography
* Nonstress tests
* BPP
* Monitor weight; nutrition guidance
Behaviors Associated With Substance Abuse
* Seeking prenatal care late in pregnancy
* Failure to keep prenatal appointments
* Inconsistent follow through with recommended care
* Poor grooming, inadequate weight gain
* Needle punctures
* Defensive or hostile reactions
* Anger or apathy regarding pregnancy
* Severe mood swings
Signs & Symptoms of Recent Cocaine Use
* Diaphoresis, HTN, tachycardia, irregular respirations
* Dilated pupils, increased body temperature
* Suddent onset of severely painful contractions
* Fetal tachycardia, excessive fetal activity
* Angry, caustic, abusive reactions; paranoia
Behaviors Indicating Possible Substance Abuse
* Irregular school attendance
* Low grades or poor school performance
* Aggressive or rebellious behavior
* Excessive dependence on peer influence
* Deterioration of relationships with family
* Rapid or extreme changes in behavior or mood
* Loss of interest in favorite activities or sports
* Changes in eating or sleeping patterns
Intimate Partner Violence (IPV)
* IPV includes a number of types of abuse:
- Physical
- Sexual
- Emotional
- Social
- Economic
* IPV is seen at all economic and educational levels
CDC reports over 10 million acts of IPV per year in US to both men and women
Physical
- Threats
- Slapping
- Pushing
- Punching/kicking
- Beating (may involve weapons and lead to death)
Sexual
- Rape
- Reproductive coercion
Social
- Isolation from family and friends
- Controlling where victim can go
Emotional
- Feeling of shame, loss of self-respect, and powerlessness
Economic
- Controlling money
- Accounting for where money was spent
- Interfering with ability to keep a job
Cycle of Violence
* Although IPV may be random, there is often a pattern
* The violence occurs in a cycle that consists of 3 phases
> Tension building
> Battering incident/explosion
> Honeymoon or calm phase
The nurse should be aware of the behaviors that accompany each phase
Characteristics of Abuser
* Wants power
* Tend to isolate, intimidate, and threaten their victims
* Extreme jealousy and possessiveness
* Attempt to control all aspects of victim’s life
> Where they go and what they wear
* Control access to money and transportation
* Low tolerance for frustration and poor impulse control
* Blames woman (victim) for the violent behavior
Cues Indicating Violence Against Women
Nonverbal
- Facial grimacing
- Slow and unsteady gait
- Vomiting
- Abdominal tenderness
- Absence of facial response
Injuries
- Welts
- Bruises or swelling
- Lacerations
- Burns
- Vaginal or rectal bleeding
- Evidence of fractures of nose, face, ribs, or arms
