Maltreatment

Question 1

What is Maltreatment

Answer 1

• Any type of intentional physical, mental, emotional, sexual or neglectful treatment of a child
• Any child under 18yrs

Question 2

Physical Neglect - Findings

Answer 2

• 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

Question 3

Physical Neglect - Behaviors

Answer 3

• Dull/inactive affect
• Excessively passive or sleepy
• Self-stimulatory bahviors
  > finger sucking, rocking
• Begging/stealing/hoarding food
• Lots of school absences
• Substance abuse
• Vandalism/shoplifting

Question 3

Emotional Abuse & Neglect

Answer 3

• Emotional abuse and emotional neglect are different; however, the common symptoms & suggestive behaviors are very similar
• Emotional nurturing is essential
• Long term effects

Question 4

Emotional Abuse & Neglect - Symptoms

Answer 4

• Failure to thrive
  > failure to grow to gain or maintain weight
• Eating/feeding disorders
• Enuresis
• Sleep disorders

Question 4

Physical Abuse

Answer 4

The non-accidental infliction of physical injury on child
Occurs in all socioeconomical, religious, cultural, racial, & ethnic groups

Question 5

Emotional Abuse & Neglect - Suggestive Behaviors

Answer 5

• Self-stimulatory behaviors
  > biting, rocking, sucking
• Lack of social smile or stranger anxiety in infant
• Unusual fearfulness
• Antisocial behavior
  > destructivenss, stealing, cruelty to animals/ppl
• Lower emotional & intellectual development
  > speech & learning disorders are common
• Attempts to harm self, including suicide

Question 6

Physical Abuse - Signs/Symptoms

Answer 6

• Unexplained bruises, burns, or fractures
• Bald spots on scalp
• Apprehensive child
• Extreme aggression
  > typically boys
• Extreme withdrawal
  > typically girls
• Fear of parents
• Enuresis or nocturesis
• Lack of crying when approached by stranger
• Spiral fractures
• Poor performance in school

Question 7

Parental Predisposing Factors

Answer 7

• Young
• Single-parent
• Substance abuse
• Isolated families
• Low self-esteem
• Parents w/out good example/similar expereinces
• Parent(s) also abused

Question 8

Child Predisposing Factors

Answer 8

• Unwanted/not planned
• Disabled
• Hyper-active (ADHD)
• Pre-mature birth
  > issues w/ bonding

Question 9

Situational Predisposing Factors

Answer 9

• Job loss
• Chronic stress
• Substance abuse

Question 10

When is abuse most likely to occur?

Answer 10

1st yr

Question 11

Shaken Baby Syndrome

Answer 11

• Physical abuse
• External signs of trauma usually absent
• Ophthalmoscopic examination reveals retinal hemorrhages
• Full bulging fontanels & head circumference greater than expected

Question 12

The Shaken Baby Syndrome Triad

Answer 12

• Retinal hemorrhaging
• Brain swelling
• Subdural hematoma

Question 13

Shaken Baby Presenting Symptoms

Answer 13

• Similar to flu
  > vomiting
  > poor feeding
  > listlessness
• Common in:
  > 3 month olds
  > colicy babies
• Typical abuser is related male living in home, often no an isolated event

Question 14

Severe Shaken Baby Syndrome Symptoms

Answer 14

• In/out consciousness
• Posteruring
• Seizures
• Bradycardia
• Death

Question 15

Sexual Abuse

Answer 15

• 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, pedophilia
• Typical abuser: known male, employed w/ children, active in community
  > play mind games, “keep it a secrete”, give gifts = grooming

Question 16

Sexual Abuse - Findings

Answer 16

• Bruises, bleeding, lacerations, or irritiation 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 vagnitits, or venereal warts
• Pregnancy in young adolescent

Question 17

Sexual Abuse - Risk Factors

Answer 17

• Unavailability of parent
• Lack of emotional closeness
• Social isolation
• Emotional desperation
• Children w/ trouble communicating

Question 18

Sexual Abuse - Behaviors

Answer 18

• Sudden appearance of sexually related problems
  > excessive/public masturbation, inappropriate sexual play, promiscuity
• Withdrawn, excessive daydreaming
• Poor relationships w/ peers
• Sudden changes
  > anxiety, weight loss/gain, clinging behaviors
• Regressive behaviors
  > bed wetting, thumb sucking
• New/sudden fears
  > men, dark, certain locations
• Running away from home
• Substance abuse
• Suicide attempts
• Rapid decline in school performance

Question 19

Munchausen by Proxy - Red Flags

Answer 19

• Phsyical evidence
• Conflicting stories
  > or blaming others sibling/sitter
• Injury tht isn’t consistent w/ hx
• Complaint tht is diff than the one associated w/ abuse
• Inappropriate response from caregivers
• Inappropriate response from child
• Previous reports of abuse in family
• Repeated ER visits

Question 20

Maltreatment - Nurse’s Role

Answer 20

• Remove child from danger
• Mandatory reporter
• Documentation
  > very thorough
  > no opinions, no feelings; 5 senses
• Eduate families on S/S & what is not okay
• Identify high risk kids

Question 21

How to Talk to a Child

Answer 21

• Provide privacy
• Don’t rush
• Don’t promise not to tell
• Don’t express shock or criticize their family
• Use their vocab to discuss body parts
• Avoid using leading statements
• Reassure they have done the right thing
• Abuse is not their fault & did nothing wrong

Question 22

Adverse Childhood Experiences (ACES)

Answer 22

• Brain is stimulated by positive & negative events
  > pathway analogy
• Toxic stress & the developing drain