Child Maltreatment and Adverse childhood experiences Flashcards
We’re going to go ahead and start by discussing what childhood maltreatment is and that is any type of intentional physical mental emotional sexual or neglectful treatment of a child under the age of 18 years every social class race religion gender and ethnicity experiences childhood maltreatment I will say though it is definitely more common in those in a lower social economic status
Lower socioeconomic status and this is directly related that increased stress of the abuser no treatment is most common and that first year of life and it can take place anywhere
Any type of intentional physical, mental, emotional, sexual or neglectful treatment of a child
Any child under the age of 18 years
Every social class, race, religion, gender, and ethnicity experiences childhood maltreatment.
What is child maltreatment?
First we’re going to discuss neglect this is the most common form of childhood maltreatment and there isn’t both physical and emotional neglect I’m going to go ahead and focus on physical neglect on this slide and then we’ll go ahead and get into emotional neglect one of the important things to remember with this type of neglect is that our child’s basic needs are not being met think Maslow’s hierarchy of needs so when you have one of these kids typically they are failure to thrive there are signs of undernutrition again that can be related to that failure to thrive if they are younger and then it’s their older than they are typically small for their age they also have poor physical and personal hygiene such as unkept hair so they have hair that they it’s not been cut it’s not been right brush
God is stopping right brush there maybe matting in it they have unclean or inappropriate dress such as wearing shorts and short sleeves when it’s snowing outside they have evidence of poor Healthcare such as delayed or lack of immunizations untreated conditions so let’s say we have a kid with strep throat and they’ve not been getting their antibiotics or kid with asthma and regularly seen in the ER because they haven’t been taking their daily medications
Because they haven’t been taking their daily medications also because I have frequent colds these kids also have unpredictable School attendance so that’s kind of another thing to think of their in and out of school or maybe switching schools a lot they also have recent injuries from lack of supervision
Current injuries from lack of supervision these are our latchkey kids these kids are kind of taken care of themselves oh their sense that inconsistent School so these kids looked look like they haven’t been well taken care of and that should always be a red flag for us these caregivers are typically absent they’re not around much and it could be related to young age a lack of Education drugs or drinking alcohol behaviors in these kiddos they’re typically dull and active they’re excessively passive or sleepy they have self-stimulatory Behavior such as rocking or finger sucking they’re begging or stealing for food or they hide food so this is common as these kids go into the foster care system
On the foster care system and they going to house that has food a lot of times they’ll steal that food not necessarily hoard it and they’ll like keep it under their bed or somewhere because they’re so worried about not having the correct amount of food to eat when they get a little bit older it’s common that they become or they get into substance abuse
Or they get into substance abuse and they start vandalizing or shoplifting
Findings:
Behaviors:
Physical neglect
Failure to thrive
Signs of undernutrition
Poor personal hygiene
Unclean/inappropriate dress
Evidence of poor healthcare (delayed immunizations, untreated conditions, frequent colds)
Recurrent injuries from lack of supervision
Inconsistent school attendance
Findings:
Dull/inactive affect
Excessively passive or sleepy
Self-stimulatory behaviors (Finger sucking, rocking)
begging/stealing food
Lots of school absences
Substance abuse
Vandalism/shoplifting
Behaviors:
emotional abuse and neglect when we discuss this it’s very important to recognize that emotional nurturing is essential for our children think about Erickson and how our kids have to trust their environment to successfully move on to the next step if we can’t trust our environment if we can’t move on if we are in fear we are not going to successfully move on to the next step and this has a life long consequences on these kids
Consequences on these kiddos so first we’ve got emotionally left and this is any sort of neglect from the caretaker that involves failure to meet the emotional needs of the child including affection attention and emotional nurturance sorry nurturing next we have emotional abuse and this is any sort of emotional abuse from the caretaker which includes rejecting isolating terrorizing ignoring corrupting verbally assaulting or overpressuring the child emotional abuse and emotional next are different however there are symptoms are very similar and very predictable some of the symptoms include failure to thrive eating and feeding disorders and enuresis which is bedwetting and this is bedwetting in a child that is potty trained with this one’s also important to recognize that some school age kids have enuresis and it’s not related to abuse so that’s something that will have to look into a little bit more and sleeping disorders as well behaviors include self-stimulatory behaviors lack of social smile or stranger anxiety
Stranger anxiety and the infant unusual feel fearfulness antisocial antisocial Behavior lower emotional and intellectual development remember we’re not making we’re not meeting our basic needs we are going to struggle to learn we can’t even trust our environment and there’s also attempts to self harm including suicide special it’s common for these kids to have speech and learning disorders
Emotional abuse and emotional neglect are different; however, the common symptoms and suggestive behaviors are very similar.
Symptoms include:
Suggestive behaviors:
Emotional abuse and neglect
failure to thrive, - (failure to grow or to gain or maintain weight.)
eating/feeding disorders,
enuresis (bed-wetting)
sleeping disorders
Symptoms include:
Self-stimulatory behaviors (biting, rocking, sucking)
Lack of social smile or stranger anxiety in the infant
Unusual fearfulness
Antisocial behavior (destructiveness, stealing, cruelty to animals/people)
Lower emotional and intellectual development (speech and learning disorders are common)
Attempts to harm self, including suicide
Suggestive behaviors:
Let’s go talk about physical abuse and this is the non accidental infliction of physical injury on the child this occurs in all socio-economical religious cultural racial and ethnic groups here are some common examples of things including unexplained bruises Burns or fractures bald spots on the scalp apprehensive child extreme aggression which is more common and boys extreme fear of parents and your racist ornakeresis lack of crying when approached by a stranger spiral fractures which that’s one of the pictures we have on here and poor performance in school I will say this other picture up here is Burns
This other picture up here is Burns which can be of like from like a cigarette Burns I warned you guys this is going to be a really fun fun lecture to listen to so let’s talk about some of the parental predisposing factors remember that most of these are going to be things that cause an increase amount of stress in the abuse
Predisposing factors: Younger parents single parent families if there’s a substance abuse or addiction involved isolated families low self-esteem and parents that did not have a good example of parenting or were abused themself okay remember it is a cycle it is a very hard cycle to stop or their lack of that’s how they view parenting is very very hard to break that cycle so child predisposing factors which is this you know it’s crazy that we even have to talk about something a child could do to predispose and that there are some things unfortunately that put a child at greater risk and these included being with not first year if it was an unwanted child if it is a child with a disability that is a hyperactive child such as ADHD or premature child and remember the kids that are premature they have a lot more issues with bonding and this is one of those reasons that’s going to put them at risk there’s also situational predisposing factors and this is also again related to increase stress this is going to include poverty
It’s also again related to increased stress this is going to include poverty job loss chronic stress and substance abuse
The non-accidental infliction of physical injury on the child. Occurs in all socioeconomical, religious, cultural, racial, and ethnic groups.
Physical abuse
Unexplained bruises, burns, or fractures
Bald spots on scalp
Apprehensive child
Extreme aggression (typically boys)
Extreme withdrawal (typically girls)
Fear of parents
Enurisis
Lack of crying when approached by stranger
Spiral fractures
Poor performance in school
The non-accidental infliction of physical injury on the child. Occurs in all socioeconomical, religious, cultural, racial, and ethnic groups.
Another example of physical abuse is shaken baby syndrome and this is a violent shaking of the infant that leads to brain rotation within the skull these sharing forces lead to tearing of blood vessels and neurons and the severe shearing leads to subdermal hematomas and retinal hemorrhages remember the baby the infants they have a large head to body ratio that they have weak neck muscles they have no control it is more common around 3 months of age and in babies that are colicky babies that commonly cry a lot a typical perpetrator is a male that is related to the infant and lives within the home and usually it is not an isolated event some of the prevent sorry some of the presenting symptoms
Presenting symptoms are similar to infant illnesses like the flu so it can be a missed especially cuz there’s not usually any outward physical bruising so these kids can come in with vomit vomiting irritability and poor feeding and listlessness and again it can commonly be missed you know if we look into the eyes we’ll see those retinal hemorrhages we don’t naturally look into the eyes that you know with aniscope that’s not you know Common Assessment we do and we think a child is coming in with the flu these kids are also have bulging fontanels and head circumference greater than expected so that is something we can pay attention to and something that is an outward son and severe cases these kids
We’ll have seizures they’ll be posturing they’ll be alterations and level of Consciousness and then we get into apnea and bradycardia and can even lead to death
External signs of trauma usually absent
Ophthalmoscopic examination reveals retinal hemorrhages
Full bulging fontanels and head circumference greater than expected
Shaken baby syndrome
Next we have sexual abuse and this is when a child is forced or persuaded to engage in any form of sexual conduct such as rape incest molestation exhibitionism child pornography child prostitution human trafficking or pedophilia typically the abuser is male and is known to the victim usually in adults they’re an active member in the community they’re employed and typically they’re employed in a position where they’re in contact with children there are also risk factors that increase the risk that a child will be sexually abused and this is includes unavailability of a parent lack of emotional closeness flexibility social isolation emotional deprivation and communication difficulties so a kiddos that have more trouble communicating the perpetrator is usually one that plays in mind games with the child they convince them to cooperate they keep it they tell them to keep it a secret they may give them gifts this is kind of that grooming process that they do for these kiddos and it’s a way to keep them the child from telling someone else
They tell them to keep it a secret they may give them gifts this is kind of that grooming process that they do for these kiddos and it’s a way to keep them child from telling someone else or telling another adult the findings that we have are typically bruises bleeding laceration or irritation of the externalia anus mouth or throat torn stained or bloody underclothing difficulty sitting or walking recurrent UTIs pain on urination penile discharge STI not specific vaginitis or venereal warts pregnancy and young adolescents and here are some of the common behaviors we see sudden appearance of sexually related problems
Problems withdrawn excessive daydreaming correlation with peers sudden changes such as anxiety weight loss or gain and cleaning behaviors regressive behaviors such as in your recess or not your races new sudden fears running away from home substance abuse suicide attempts and Rapid decline in school performance
When a child is forced or persuaded to engage in any form of sexual conduct (or simulation)
Includes: rape, incest, molestation, exhibitionism, child pornography, child prostitution, human trafficking, and pedophilia
Findings
Behaviors
Sexual abuse
Bruises, bleeding, lacerations, or irritation of external genitalia, anus, mouth or throat.
Torn, stained, or bloody underclothing
Difficulty sitting or walking
Recurrent UTIs
Pain on urination
Penile discharge
STI, nonspecific vaginitis, or venereal warts
Pregnancy in young adolescent
Findings
Sudden appearance of sexually related problems (excessive/public masturbation, inappropriate sexual play, promiscuity)
Withdrawn, excessive daydreaming
Poor relationships with peers
Sudden changes (anxiety, weight loss/gain, clinging behavior)
Regressive behaviors (bedwetting, thumb sucking)
New/sudden fears (men, dark, certain locations)
Running away from home
Substance abuse
Suicide attempts
Rapid decline in school performance
Behaviors
Physical Abuse: Munchausen By Proxy
When parent, mom typ, has mental illness portray that child has that illnesss
Attention seeking thing
Undergo lot diff procedures and medical testing
Hard to catch because switch practitioners all time
Munchausen by proxy
Here are some common red flags that us as nurses need to pay special attention to and these include physical evidence conflicting stories such as one passes one thing another princess another or the what the kid says doesn’t match with the parents say injury that isn’t consistent with history a complaint that is different than the one associated with the abuse inappropriate response from the caregiver inappropriate response from the child previous reports of abuse
It’s from the caregiver inappropriate response from the child previous reports of abuse in the family and repeated ER visits
Physical evidence
Conflicting stories (or blaming others sibling/sitter)
Injury that isn’t consistent with history
Complaint that is different than the one associated with abuse
Inappropriate response from caregivers
Inappropriate response from child
Previous reports of abuse in the family
Repeated ER visits
Red flags
