A nurse is assessing a child who has been brought to the emergency department by his mother. The nurse notices multiple bruises on the child's arms and legs, some of which are in different stages of healing. The nurse suspects that the child is a victim of:

Choice A Reason: Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event, such as sexual abuse. Symptoms of PTSD include re-experiencing the trauma through flashbacks, nightmares, or intrusive thoughts; avoiding reminders of the trauma; feeling numb or detached; and having increased arousal, such as being easily startled, irritable, or hypervigilant.

Choice B Reason: Depression is a mood disorder that causes persistent feelings of sadness, hopelessness, and loss of interest in activities that were once enjoyable. Symptoms of depression include low mood, low self-esteem, guilt, worthlessness, fatigue, insomnia or hypersomnia, appetite changes, weight changes, difficulty concentrating, and suicidal thoughts or behaviors.

Choice C Reason: Substance abuse is the harmful use of alcohol, drugs, or other substances that impair one's physical or mental health or social functioning. Substance abuse can be a coping mechanism for some survivors of sexual abuse, as they may use substances to numb their pain, escape their reality, or self-medicate their symptoms.

Choice D Reason: Eating disorders are serious mental health conditions that involve abnormal eating behaviors and attitudes toward food and body weight. Eating disorders can be triggered by sexual abuse, as survivors may develop distorted body image, low self-esteem, shame, guilt, or a sense of loss of control over their lives. Eating disorders can include anorexia nervosa (restricting food intake to achieve extreme thinness), bulimia nervosa (binging on large amounts of food and then purging through vomiting, laxatives, or exercise), binge eating disorder (binging on large amounts of food without purging), or other specified feeding or eating disorder (OSFED) (having symptoms of an eating disorder that do not meet the full criteria for any specific diagnosis).

Choice E Reason: All of the above are possible signs and symptoms of sexual abuse in children and adolescents. However, not all survivors of sexual abuse will develop these conditions, and not all people with these conditions have experienced sexual abuse. Therefore, it is important to assess each individual case holistically and provide appropriate support and referrals as needed.

The correct answer is D. Neglect is the failure to provide for a child’s basic physical, emotional, educational, or medical needs. Examples include inadequate food, clothing, shelter, supervision, affection, education, or health care for a child. A cluttered and dirty house, an empty refrigerator, and parental conflict are signs of neglect.

Choice A Reason: Physical abuse is the intentional use of physical force against a child that results in or has a high likelihood of resulting in harm to the child’s health, survival, development, or dignity. Examples include hitting, kicking, shaking, burning, or poisoning a child. A cluttered and dirty house, an empty refrigerator, and parental conflict are not specific signs of physical abuse, although they may increase the risk of accidental injuries.

Choice B Reason: Sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent. Examples include fondling, penetration, exposure to pornography, or prostitution of a child. A cluttered and dirty house, an empty refrigerator, and parental conflict are not signs of sexual abuse, although they may increase the vulnerability of the child to sexual exploitation.

Choice C Reason: Emotional or psychological abuse is the intentional or unintentional acts or omissions that cause or have a high probability of causing harm to a child’s emotional development or self-esteem. Examples include humiliation, threats, isolation, rejection, or belittling a child. A cluttered and dirty house, an empty refrigerator, and parental conflict are signs of emotional abuse, as they may create a stressful and chaotic environment for the child.