Child Abuse

• Child Abuse

• Child abuse can be classified into four main types: physical abuse; sexual abuse; emotional abuse; neglect.

• Physical abuse is the intentional use of physical force that results in or has the potential to result in physical injury to a child. Examples of physical abuse are hitting; kicking; punching; slapping; shaking; throwing; burning; biting; choking; poisoning; using weapons.

• Sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend or consent to or is not developmentally prepared for or violates the laws or social taboos of society. Examples of sexual abuse are fondling; oral sex; anal sex; vaginal sex; penetration with objects; exposure to pornography; prostitution; trafficking; incest; rape.

• Emotional abuse is the persistent emotional maltreatment of a child that causes severe and adverse effects on the child’s emotional development. Examples of emotional abuse are verbal insults; threats; humiliation; rejection; isolation; ignoring; blaming; manipulating; intimidating; controlling; withholding affection; denying emotional responsiveness.

• Neglect is the failure to provide for a child’s basic physical or emotional or educational or medical or dental needs. Examples of neglect are inadequate food or clothing or shelter or hygiene or supervision or protection or stimulation or affection or education or health care or dental care.

• Clinical Manifestations of Child Abuse

  

• The clinical manifestations of child abuse may vary depending on the type and severity and duration and frequency of the abuse and the age and developmental stage and personality and coping skills of the child.

• Behavioral signs: such as fear or anxiety or depression or aggression or withdrawal or low self-esteem or poor social skills or difficulty trusting others or difficulty forming attachments or difficulty expressing emotions or difficulty coping with stress or difficulty concentrating or learning or memory problems or nightmares or sleep problems or eating problems or substance use problems or self-harm or suicidal thoughts or behaviors.

• Sexual signs: such as sexualized behavior or language or knowledge that is inappropriate for the child’s age or developmental level. The child may also show signs of genital or anal trauma or irritation or infection or pain or bleeding or discharge or pregnancy or STIs.

• Nursing Assessment of Child Abuse

• The nursing assessment of child abuse involves collecting subjective and objective data from the child and the caregiver and other sources such as family members, teachers, social workers, or health care providers.

• The nursing assessment of child abuse should be done in a safe, private, and comfortable environment with the child’s consent and cooperation. The nurse should use a calm, gentle, and supportive approach and avoid leading, suggestive, or judgmental questions. The nurse should also use developmentally appropriate language and tools such as dolls, drawings, or games to facilitate communication with the child.

• The nursing assessment of child abuse should include the following components:

  • History: The nurse should obtain a comprehensive history of the child’s physical, mental, emotional, social, and spiritual health and development; family structure and dynamics; cultural background and beliefs; exposure to abuse or violence; current situation and concerns; coping strategies and support systems; strengths and resources.

  • Physical examination: The nurse should perform a thorough physical examination of the child’s head, neck, chest, abdomen, back, extremities, genitals, anus, and skin. The nurse should document any signs of injury or trauma such as location, size, shape, color, pattern, stage of healing, and consistency with the history given by the child or caregiver. The nurse should also assess the child’s vital signs, growth parameters, nutritional status, developmental milestones, and immunization status.

  • Laboratory tests: The nurse should order laboratory tests as indicated by the history and physical examination. Some of the common laboratory tests for child abuse are complete blood count (CBC), coagulation studies, electrolytes, liver function tests (LFTs), renal function tests (RFTs), urine analysis (UA), urine toxicology screen (UTS), blood alcohol level (BAL), blood cultures, wound cultures, STI tests, pregnancy tests.

  • Diagnostic tests: The nurse should order diagnostic tests as indicated by the history and physical examination. Some of the common diagnostic tests for child abuse are x-rays, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, ultrasound, electroencephalogram (EEG), electrocardiogram (EKG), echocardiogram, bone scan, skeletal survey.

• Nursing Interventions for Child Abuse

• The nursing interventions for child abuse are based on the nursing process and evidence-based practice. The nursing interventions for child abuse aim to prevent further harm; protect the child’s rights; promote the child’s safety; report the suspected or confirmed abuse; refer the child and the caregiver to appropriate services; educate the child and the caregiver about abuse prevention and treatment; support the child’s physical, mental, emotional, social, and spiritual healing; and evaluate the outcomes of care.

• Some of the common nursing interventions for child abuse are:

  • Prevention: The nurse should implement primary, secondary, and tertiary prevention strategies to reduce the risk of child abuse. Primary prevention strategies include providing education, information, and resources to parents, caregivers, children, and communities about child development, parenting skills, stress management, conflict resolution, anger management, substance use prevention, and abuse prevention. Secondary prevention strategies include screening children and caregivers for risk factors or signs of abuse; providing counseling, therapy, support groups, home visits, crisis intervention, and respite care to families at risk of abuse; and monitoring children and caregivers for changes in behavior or health status. Tertiary prevention strategies include reporting suspected or confirmed abuse to the appropriate authorities; providing medical care, legal assistance, social services, shelter, protection orders, and advocacy to children and caregivers who have experienced abuse; and facilitating reunification or alternative placement for children who have been removed from their homes due to abuse.

  • Protection: The nurse should protect the child’s rights according to the United Nations Convention on the Rights of the Child. The nurse should respect the child’s dignity, autonomy, privacy, confidentiality, and participation in decision-making. The nurse should also protect the child from further harm by ensuring a safe and secure environment; removing or minimizing any potential sources of danger; and providing appropriate equipment, supplies, and medications to prevent or treat complications or infections. The nurse should also protect the child from re-traumatization by avoiding unnecessary or repeated examinations or procedures; using a trauma-informed approach; and providing emotional support and comfort to the child.

  • Reporting: The nurse should report any suspected or confirmed cases of child abuse to the appropriate authorities as mandated by the law and the professional code of ethics. The nurse should follow the reporting protocol of the institution or agency where he or she works. The nurse should document the facts and evidence of the abuse in a clear, concise, and objective manner. The nurse should also inform the child and the caregiver about the reporting process and their rights and responsibilities. The nurse should cooperate with the investigation and provide any additional information or testimony as required.

  • Referral: The nurse should refer the child and the caregiver to appropriate services that can provide further assessment, treatment, support, and follow-up. Some of the common services that the nurse can refer to are:

    • Medical services: such as pediatrician, surgeon, dentist, ophthalmologist, otolaryngologist, dermatologist, gynecologist, urologist, endocrinologist, neurologist, psychiatrist, psychologist, nurse practitioner, physician assistant, nurse, social worker, pharmacist.

    • Legal services: such as lawyer, judge, prosecutor, defense attorney, police officer, detective, forensic examiner, child advocate, guardian ad litem, court-appointed special advocate (CASA).

    • Social services: such as child protective services (CPS), foster care, adoption, kinship care, group home, residential treatment center, shelter, transitional housing, independent living program.

    • Educational services: such as teacher, counselor, tutor, special education teacher, speech therapist, occupational therapist, physical therapist, school nurse, school social worker.

    • Community services: such as child abuse prevention program, family resource center, crisis hotline, helpline, support group, peer mentor, mentor, volunteer, faith-based organization.

  • Education: The nurse should educate the child and the caregiver about abuse prevention and treatment. The nurse should provide accurate, relevant, and understandable information about the causes, types, effects, and signs of abuse; the reporting process and legal implications; the available services and resources; the treatment options and outcomes; the coping strategies and self-care techniques; the safety planning and protection measures; the rights and responsibilities of the child and the caregiver; and the importance of follow-up and adherence to care.

  • Support: The nurse should support the child’s physical, mental, emotional, social, and spiritual healing. The nurse should provide holistic and culturally sensitive care that meets the individual needs and preferences and goals of the child. The nurse should also provide therapeutic communication and active listening and empathy and validation and encouragement and praise to the child. The nurse should also facilitate the development of a trusting and respectful and collaborative relationship with the child. The nurse should also promote the empowerment and resilience and recovery of the child. The nurse should also involve the family or significant others or community members in the care of the child as appropriate.

  • Evaluation: The nurse should evaluate the outcomes of care for the child and the caregiver. The nurse should use standardized tools or scales or questionnaires or interviews or observations to measure the progress or improvement or achievement of the expected outcomes. The expected outcomes may include:

    • The child is free from further harm or injury.

    • The child reports or demonstrates reduced pain or discomfort.

    • The child’s physical wounds or infections are healed or treated.

    • The child’s vital signs or laboratory tests or diagnostic tests are within normal limits or show improvement.

    • The child’s growth parameters or developmental milestones are appropriate for age or show improvement.

    • The child reports or demonstrates reduced fear or anxiety or depression or aggression or withdrawal or low self-esteem or poor social skills or difficulty trusting others or difficulty forming attachments or difficulty expressing emotions or difficulty coping with stress or difficulty concentrating or learning or memory problems or nightmares or sleep problems or eating problems or substance use problems or self-harm or suicidal thoughts or behaviors.

    • The child reports or demonstrates increased happiness or confidence or self-worth or self-esteem or social skills or trust in others or attachment to others or expression of emotions or coping with stress or concentration or learning or memory skills.

    • The child reports having a positive outlook on life and a sense of meaning and purpose.

    • The child reports having a supportive network of family members, friends, peers, mentors, professionals, and community members.

    • The child reports having a safe and secure environment at home, school, work, community or institutional care. The child reports having a safety plan and protection measures in place. 

      • - The child reports or demonstrates reduced involvement or exposure to abuse or violence or trauma or stressors. 

      • - The child reports or demonstrates increased involvement or participation in positive activities or hobbies or interests or goals. 

      • - The child reports or demonstrates increased adherence to medical care, legal assistance, social services, educational services, community services, and follow-up appointments. 

      • - The child reports or demonstrates increased satisfaction with the quality of care and the relationship with the nurse and other professionals.

      •  - The caregiver reports or demonstrates reduced risk factors or signs of abuse; increased protective factors or signs of support; increased knowledge and skills about child development, parenting, stress management, conflict resolution, anger management, substance use prevention, and abuse prevention; increased awareness and acceptance of the child’s needs and feelings; increased communication and cooperation with the child and other professionals; increased adherence to medical care, legal assistance, social services, educational services, community services, and follow-up appointments; increased satisfaction with the quality of care and the relationship with the nurse and other professionals.

• The nurse should also monitor for any complications or adverse effects of the abuse or the treatment such as infection, bleeding, shock, organ failure, sepsis, death, re-injury, re-victimization, re-traumatization, non-compliance, relapse, recurrence, dissatisfaction, dissatisfaction.

• The nurse should also modify the plan of care as needed based on the evaluation of the outcomes and the feedback from the child and the caregiver. The nurse should also collaborate with other members of the interdisciplinary team to ensure continuity and coordination of care. The nurse should also document the evaluation of the outcomes and any changes in the plan of care in a clear, concise, and objective manner.

•  

• Some of the common clinical manifestations of child abuse are:

  • Physical signs: such as injuries or bruises or burns or fractures or scars or bites or infections or bleeding or pain or swelling or marks from objects or cords or belts. The injuries may be in various stages of healing or inconsistent with the history given by the child or caregiver or located in unusual places such as genitals or buttocks or back or face. The child may also show signs of malnutrition or dehydration or poor growth or developmental delay or failure to thrive.