Classi Cardinal Signs Of Child Abuse

Child Advocacy

Child maltreatment has many different characteristics, including child neglect and physical abuse (Wong, Hockenberry & Wilson, 2011). It is defined as “any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm,” (Children 's Bureau, 2008). Children suffering from child abuse or neglect usually share a series of indicative behaviors and findings (Wong, Hockenberry & Wilson, 2011). As a healthcare provider, it is crucial to recognize the cardinal signs of child abuse at the earliest stage possible (Wong, Hockenberry & Wilson, 2011).
Classic physical signs that point to a child being abused can include bruises in the shape of an object (ex: hand), in areas of the face, back, thighs, or buttocks (Wong, Hockenberry & Wilson, 2011).
The child may exhibit burns on their palms or soles of their feet, often times resembling cigarette burns or burns from searing hot water (Wong, Hockenberry & Wilson, 2011). Fractures are commonly found in multiple bones of the body, often in different phases of healing (Wong, Hockenberry & Wilson, 2011). Nausea, vomiting, and abdominal swelling may appear from the child being punched in the in the stomach area by their abuser (Wong, Hockenberry & Wilson, 2011). Poisoning and drug overdose occurring with no explanation may also be seen if the caregiver has purposefully poisoned the child (Wong, Hockenberry & Wilson,
2011). Indications of child abuse not only include physical findings, but can also include more subtle clues. This can include aggressive behavior solely in search of attention, as well as fear towards their parents or other adults (Wong, Hockenberry & Wilson, 2011). Children experiencing abuse may often appear to be dull or withdrawn from their surroundings, and are often consumed with daydreaming (Wong, Hockenberry & Wilson, 2011). Substance abuse, drug use, failure in school, and running away from home are also commonly seen in adolescents being abused (Wong, Hockenberry & Wilson, 2011). The nurse plays a fundamental role in identifying and preventing further abuse of a child (Wong, Hockenberry & Wilson, 2011). If neglect or abuse is suspected, it is required that the nurse report it to the proper authorities immediately (Wong, Hockenberry & Wilson, 2011). The nurses’ priority in dealing with an abuse case is to “remove the child from the abusive situation to prevent further injury,” (Wong, Hockenberry & Wilson, 2011). In order to do this, the nurse must collect solid evidence of mistreatment, including a detailed history of the event and complete physical assessment (Wong, Hockenberry & Wilson, 2011). With that said, the biggest red flag signifying abuse is a mismatch between the history given and the physical findings of the child (Wong, Hockenberry & Wilson, 2011). In regards to the given scenario, the expected assessment for a 2-month-old with Suspected Non-Accidental Trauma and bilateral subdural hematomas would probably show very few signs of physical injury at first glance (Wong, Hockenberry & Wilson, 2011). Subjective findings would most likely include poor feeding, irritability, and lethargy (Mayo Clinic Staff, 2011). The infant may lie very still upon examination, or show signs of distress including facial grimacing and inconsolable crying (Wong, Hockenberry & Wilson, 2011). Objective findings may include vomiting, seizures, pallor, loss of consciousness, and bradycardia (Mayo Clinic Staff, 2011). Other injuries that may be found upon further assessment include damage to the spine, rib fractures, and retinal detachment (Mayo Clinic Staff, 2011). When obtaining the history from the mother and boyfriend, it would be expected for some pieces to be missing. Incongruence between the history and physical assessment is common, including an unclear explanation of injury (Wong, Hockenberry & Wilson, 2011). The said cause of injury may end up being not probable given the child’s age (Wong, Hockenberry & Wilson, 2011). For instance, the mother and boyfriend may state that the infant rolled off the bed. Considering the extent of the injury, this is not a probable explanation since baby’s bones are typically soft and not easily damaged (Wong, Hockenberry & Wilson, 2011). While assessing the family, the mother-child interaction would be noted. This might include lack of concern towards the child or even complete absence from the child’s bedside (Wong, Hockenberry & Wilson, 2011). Often times the abusers will not show affection or try to comfort the child (Wong, Hockenberry & Wilson, 2011). Planning for the child would include an expected outcome that the child will be protected from any further abuse (Wong, Hockenberry & Wilson, 2011). Interventions to be carried out by the nurse include keeping accurate, factual records of the assessment findings regarding both the patient and family (Wong, Hockenberry & Wilson, 2011). The nurse will report any suspicions of child neglect or abuse to the appropriate authorities per hospital policy (Wong, Hockenberry & Wilson, 2011). The nurse will also work in partnership with the healthcare team and assist in removing the child from the abusive setting, which may include appearing in court to present evidence of abuse, as well as preparing the child for a foster care setting (Wong, Hockenberry & Wilson, 2011). A measurement in relationship to these interventions would include and following up with the appropriate agencies and properly advocating for the child (Wong, Hockenberry & Wilson, 2011). Planning for the family would have an expected outcome of receiving sufficient support regarding their situation (Wong, Hockenberry & Wilson, 2011). To ensure this, the nurse would help the family identify the reasons why the abuse occurred in the first place, such as persistent crying of the infant (Wong, Hockenberry & Wilson, 2011). The nurse will provide education to the parents regarding shaken baby syndrome, including how it is caused and its detrimental effects (Wong, Hockenberry & Wilson, 2011). The nurse will also provide the parents with alternate coping tools when becoming stressed with the child, such as breathing techniques (Wong, Hockenberry & Wilson, 2011). The nurse can evaluate the parents’ progress by asking them open-ended questions on what she has taught them (ex: what are two non-aggressive ways to deal with a crying child?) (Wong, Hockenberry & Wilson, 2011). When dealing with emotional situations regarding families and children, specifically child abuse cases, my initial affective response is sympathy and resentment towards the child’s abuser. I generally feel this way since many children and babies really are helpless and can’t defend themselves in most situations. I don’t think any child should be taken advantage of, and believe no child should have to endure an abusive situation. Ways to cope with these feelings consist of trying understanding the reason behind the abuse (Wong, Hockenberry & Wilson, 2011). For example, an uneducated parent may have a child that is not intentionally neglected, rather just a matter of not knowing the proper parenting skills (Wong, Hockenberry & Wilson, 2011). Another coping mechanism is to detach your emotions from the situation (Wong, Hockenberry & Wilson, 2011). By doing this, it allows you maintain professionalism and provide care for both the patient and family. Allowing yourself to talk about your feelings, given a private place and time, can also help in coping with emotional situations (Wong, Hockenberry & Wilson, 2011).

References
Children 's Bureau, A. F. C. A. F. (2008). Child welfare information gateway. Retrieved from https://www.childwelfare.gov/pubs/factsheets/whatiscan.cfm Mayo Clinic Staff. (2011, October 26). Mayo clinic. Retrieved from http://www.mayoclinic.com/health/shaken-baby-syndrome/DS01157 Wong, D., Hockenberry, M., & Wilson, D. (2011). Wong 's nursing care of infants and children.
(9th ed.). St. Louis, MO: Elsevier Inc.