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What is child abuse?
- Physical neglect and physical abuse
- Emotional abuse and neglect
- Sexual Abuse
- verbal ABuse
Who is an abused child?
- When a parent or another person who is legally responsible for the child's care:
- Inflicts or allows another to inflict physical or emotional pain or injury
- Creates or allows another to create a significant risk of serious physical or emotional pain or injury
- Commit or allows another to commit an act of sexual abuse, as defined by law, against the child
What is the difference between abuse and neglect?
- Abuse: The act of doing something physically, emotionally or sexually
- Neglect: Not providing adequate nutrition, emotional contact or physical care
What is physical abuse and what are some indications of physical abuse?
- Physical abuse is the deliberate mistreatment of another individual that inflicts pain or injury and may result in permanent or temporary disfigurement or even death
- Clinical manifestations include:
- bruises in multiple stages of healing
- Burns or scalding in stocking or gloves patterns or distributions
- Burn scars in different stages of healing
- Rope, belt, or cord marks usually seen on mouth, legs, buttocks, and arms
- Multiple fractures in different stages of healing
- Sedation from overmedication
- SOB or distress when being moved due to chest bruising and cracked ribs
- Exacerbation of chronic illness due to withholding of medications
- Behaviors inconsistent with developmental age may be apparent
What are some risk factors for physical abuse?
- Premature birth of the child
- Unrelated male caregiver with access to the child
- Parents were abused
- Child <3 y/o
- Handicap child
- Parental substance abuse
- Parental social isolation
What is sexual abuse and what are some common forms?
- Sexual abuse is exploitation of a child for the sexual gratification of an adults
- Sexual abuse includes: oral-genital contact, fondling or caressing of genitals, anal or sexual intercourse, rape or sodomy, and prostitution
What are some risk factors for sexual abuse?
- Absence of a natural father figure
- Being female
- Mother is employed outside of the home
- Poor relationships
- Parental relationship conflict
- Parental substance abuse
- Parental social isolation
What is emotional abuse?
- Involves shaming, ridiculing, embarrassing or insulting the child
- Can also include destruction of the child's personal property, such as tearing up of photos, letters or harming/killing/giving away of pet
- Verbal abuse is a common form of emotional abuse
What is emotional neglect?
- Characterized by the caretaker's emotional unavailability to the child (withholding love)
- Child suffers from lack of nurturance and failure of the parent/caretaker to meet basic dependency needs (may result in failure to thrive)
What are some signs of physical neglect?
- Undernourishment (may show up as stunted growth on growth chart)
- Unclean clothes and body
- Poor dental health (extensive dental caries)
- Inappropriate clothing for the season/weather
What are some signs of emotional abuse?
- Fear, poor physical growth (failure to thrive)
- Failure to meet important developmental milestones
- Difficulty relating to adults
- Impaired communication skills
- Developmental delays
What are some signs of sexual abuse?
- Exhibit variety of physical and behavioral sign and symptoms
- Does not always result in apparent injury
- Long term consequences ongoing (shame, guilt, anger, decreased self esteem, hostility)
What are some physical and behavioral manifestations of sexual abuse?
- Vaginal discharge
- Genital edema, erythema or ecchimosis
- Bloodstained underpants
- UTIs or STDs
- Difficulty walking or sitting
- Difficulty sleeping or bedwetting or nightmares
- Changes in school work and attendance
- Fear of strangers
- Excessive sexual curiosity or play
- Constant masturbation
- Curling into the fetal position
- Changes in eating habits or abrupt changes in behavior
- Females may take on the role of a wife or mother
Who is the most common abuser?
The child's parents or caretakers
Name some diagnostic tests for child abuse and neglect
- Careful History
- Thorough Physical Assessments
- X-ray studies
- Neglect often needs hospitalization leading to a full medical, social, and psychiatric eval
What are some medical management and goals for the abused or neglected child?
- Treatment goals include preventing self destructive and dangerous actions
- Child is encouraged to express fears and feeling in a safe and supportive environment
- Child will need to build appropriate coping skills
- Art therapy is often used as it is not threatening to the child
- Family and group therapy may be used
- Child must be reassured and convinced they are not to blame for the abuse they sustained
What are the legal and ethical implications for the nurse when it comes to child abuse?
- Any person working with children is required to report suspected abuse
- Reports made in good faith cannot be countersued
- Any person who has suspected abuse but does not report may be held responsible by the courts
Describe a complete nursing assessment for suspected abuse
- Required extensive medical history and physical exam
- Use therapeutic communication, an unhurried environment and a nonjudgmental attitude
- When do a health history assessment, begin with the least threatening topic (such as parental concerns to gen fam hist to specific child hist)
- It is best to interview the child both with and without their guardian
- Observe how the parent or caretaker interacts with the child
- Are there any discrepancies between the PMH and current physical assessment (such as injuries that don't match the report of parents)
How can culture influence the diagnosis of abuse?
- Assess the family and child's culture as some culturals have practices that would normally be considered abuse, but are used for healing in that culture
- Documents all findings and interactions with the family
- Contact protective services if an investigation is warranted
How should the nurse document any findings of abuse?
- Physical findings should be documented as observed using figure diagrams for all injuries
- Photographs may be take to document the nature, and extent of injuries
- Documentation should not include personal opinions or judgment
- Documentation needs to be thorough in case of a pending investigation!
What are nursing interventions for abuse?
- Teach the child anxiety reding techniques
- Assist the child in managing their feelings
- Teach the child assertiveness skills
- Assists the child in developing problem solving skills
- Assist the child in value-building and clarification
- Assist the child in enhancing coping mechanisms
What is Munchausen Syndrome by Proxy?
- Form of child abuse that involves the fabrication of signs and symptoms of health concerns in a child
- The parent or caretaker may cause these signs and symptoms to gain access to the medical system (parent or guardian is often a member of the medical field)
- More common in children under age 6
- When unexplained, recurrent or extremely rare condition occur in the presence of the caretaker, but is not seen when the child is separated from that caretaker
- Suspicion required coordinated evaluation by an interdisciplinary team
What are some agencies to contact for child abuse?
- Children and Youth: specific to the county the abuse was reported to
- Nurse Family Partnership: funded by PA commission on crime and delinquency with a visitation program. This program is scientifically proven to reduce chid abuse