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What age group has the highest rate of child abuse?
age birth to 1 year old
their crying makes ppl crazy
Abuse in order of prevalence? (4)
neglect, physical, psychological, sexual
Why do most ppl neglect their children?
What should the nurse do even if it is not extreme neglect?
parent for some reason cannot take care of child, but most want to
do something about
do not blame the parent
S/S of neglect?
- 1. inappropriate dress
- 2. hungry all the time: hoarding food at school
- 3. poor hygiene: staff infection
- 4. rashes
- 5. consistent lack of supervision: left alone
- 6. medical neglect: not taken to the MD not r/t financial
- 7. abandonment
- 8. nonorganic failure to thrive
- 9. missing a lot of school
When should nurse report s/s of neglect/abuse?
mandatory reporting for reasonable suspision
do not have to prove it
Serious abuse rates are highest in ____ & ____ pt.
infants and medicaid pt
- P- peak of crying - cry more each week until 2 months old then less at 3-5 mo old
- U- unexpected - crying can come and go for no reason
- R- resists soothing - may cry nonstop no matter what you do
- P- pain-like face - may look like they are in pain even if they arent
- L- long lasting - can last up to 5 h per day
- E- evening - may cry more in late pm
Shaken baby syndrome?
causes coup-contrecoup injury with BV sheared off b/c head is so big and
Complications of shaken baby?
sheared BV with subdural hematomas and intracranial hemorages, retinal hemorrhages, cranial and skeletal fractures, posterior rib fractures
Number one red flag for child abuse?
history doesn't fit the clinical picture
S/S of shaken baby syndrome?
- 1. lethargy
- 2. irritability
- 3. vomiting
- 4. fever
- 5. poor feeding
- 6. breathing abnormalities
- 7. apnea
- 8. bulging fontanel
- 9. seizures
Complication of shaken baby syndrome?
long term neuro defects
4 perpetrators of shaken baby syndrome in order of prevalence?
father, stepfather, mother, baby sitters
How can shaken baby syndrome be reduced?
education of caregivers about the risks
What to teach CG about babys who cry a lot?
sometimes OK to just let them cry
Intervention to encourage parent and point out a bond b/t baby and parent?
let parent know they are doing good and point out a detail that shows bond b/t parent and child
Teaching about a baby that cries a lot?
- 1. make sure all needs are met
- 2. make sure not sick or have temp
- 3. recognize when they are getting frustrated and have a plan
- 4. put baby in crib on back and step away for a while
- 5. good if can call support person to come get the kid
In all age groups who is most at risk for child abuse?
children who get medicaid
Family risk factors that increase abuse potential?
- 1. escalating stress levels
- 2. social isolation with no support
- 3. unstable family situations: domestic violence, alcohol, drugs
- 4. parent with depression
- 5. young, single parent with no one to help
- 6. lower education level
- 7. parent who was abused as a child
Risk factors associated with the child?
- 1. preemies - require a lot of care
- 2. disabilities in child
- 3. first-born child may be abused more
- 4. stepchild
- 5. if child has been abused once much higher risk for next abuse
Questions that can clue that there could be a prob?
- 1. who helps
- 2. how are you handling it
- 3. is it what you expected
- 4. what do you think is the hardest part
S/S of child abuse?
- 1. delay in seeking medical help
- 2. evasiveness/vagueness
- 3. initial report of no trauma
- 4. changing story
- 5. evidence of previous injuries
- 6. inconsistencies/ clinical findings do not match Hx
2 cultural practices that may be mistaken for abuse?
coining and cupping
What is coining?
purposefully bring the blood to the surface to get rid of fever and illness
What is cupping?
take a cup and put a candle under it to get all the O2 out of it then put it on the back to suction it- to get rid of pain
What types of marks are deliberate?
usually linear or circular
Characteristics of bruising that signal abuse?
- 1. unexplained
- 2. in different stages of healing
- 3. in strange patterns
Characteristics of burns that are intentional?
normal burns are splatter burns
intentional will be sock or mitten burns
Mouth trauma and abuse?
can be caused by putting bottle in too hard and tear frenulum
Abuse and ear trauma?
bruises on the back indicate abuse
Bite marks and abuse?
little kids bite each other
measure the bit mark- if it is big ppl teeth it is child abuse
First priority with child abuse?
do whatever you need to do to protect the child
do not let the child leave with the child: lie
Types of emotional abuse?
verbal, extreme punishment that terrorizes the child, corruption, not showing affection
S/S of emotional abuse?
- 1. extremes in behavior being very aggressive or very passive
- 2. delayed physical, emot, or intellectual dev
- 3. low self esteem
- 4. depression
- 5. anxiety
- 6. clingy/needy
- 7. probs with school work
- 8. alc, drugs
- 9. eating disorders
- 10. scuicidal
- 11. criminal behavior
S/S of sexual abuse?
- 1. regression: bedwetting, thumb sucking
- 2. new words for private body parts that parents didn't teach them
- 3. don't want to remove clothing when it would be appropriate
- 4. play sexual games or play sexually with dolls
- 5. wetting, soiling accidents that are not related to potty training - can be a sing of trauma
- 6. self-injury
- 7. inadequate personal hygeine and weight gain
- 8. sexual promiscuity
- 9. compulsive eating or eating disorders
Physical S/S of sexual abuse?
- 1. pain, discoloration
- 2. around genitals or mouth
- 3. sti
- 4. pain on urination or defecation
Best way to prevent sexual abuse?
- 1. diff b/t good and bad touch
- 2. know that they can say no
- 3. with kids need to use concrete examples
Consequences of abuse?
- 1. more teen pregnancy
- 2. be arrested as adults and juvenile
- 3. more likely to do violent crime
- 4. more likely to have a psychological disorder
- 5. economic cost of medical treatment
- 6. more likely to abuse their children
- 1. Try to remain objective and give facts with no opinions or conclusions you've drawn
- 2. report the abuse to child protective services NOT your nursing supervisor
- 3. reporter should someone who has firsthand knowledge of the facts
How do you behave around a suspected abuser?
do not be accusatory and allow them to know that you suspect them of abuse
don't act any differently that you normally would and STAY with the child
Common excuses to not reprot?
- 1. probably wrong
- 2. don't want to interfere
- 3. break up home
- 4. they'll know it was me
- 5. It won't make any difference anyway
Stopping abuse in a public place?
- 1. start a conversation with the adult to divert att. from the child: Say that ch can wear you out and ask if there is anything you can do to help
- 2. Talk to child to divert their att if they are misbehaving
- 3. Look for the first oppurtunity to praise the adult or child
- 4. Offer assistance if the child is in danger
- 5. Avoid negetive remarks or looks
3 ways nurse can prevent child abuse?
- 1. educate parents
- 2. be aware of support groups
- 3. voluteer
8 behavioral indicators of physical abuse?
- 1. self destructive
- 2. withdrawn and/or aggressive
- 3. arrives early and stays late to school - doesn't want to go home
- 4. chronic runaway
- 5. complains of soreness or moves uncomfortably
- 6. wears clothing inapporpriate to weather to cover body
- 7. bizarre explanation of injuries
- 8. wary of adult contact
7 behavioral S/S of physical neglect?
- 1. regular fatigue/listlessness
- 2. steals food, begs
- 3. reports no CG at home
- frequently absent or tarsdy
- 4. self destructive
- 5. school dropout
- 6. extreme lonliness and need for affection
6 behavioral S/S of sexual abuse?
- 1. excessive seductiveness
- 2. role reversal, overly concerned for siblings
- 3. massive weight change
- 4. suicide attempts
- 5. inappropriate sex play or premature understanding of sex
- 6. thretended by phys contact, closeness
6 S/S of emotional abuse?
- 1. habit disorder
- 2. antisocial, destructive
- 3. neurotic traits
- 4. passive and aggressive behavior extremes
- 5. developmentally delayed