Child Abuse

• HARM INFLICTED INTENTIONALLY (physical or mental)

• UNSAFE ACTS THAT COULD CAUSE INJURY (even if it doesn’t injure the child)

• RECRUITING OTHERS TO HARM THE CHILD (ACTIVE ENCOURAGEMENT)

• THREATENING/VIOLENT BEHAVIOR AROUND CHILD, demonstrates a DISREGARD for the presence of the child and could reasonably result in serious injury to the child (ex. cases of DOMESTIC VIOLENCE in the home)

HURT

What does CHILD ABUSE mean?

1 in 4 girls and 1 in 13 boys before 18 yrs of age

Which gender of children are most likely to suffer from abuse?

NONACCIDENTAL, 2 YEARS OF AGE

80% of fatal head injuries are ______ under ____ of age?

• 59% FEMALE

• 41% MALE

• 81% PARENT

What percentages of people who are perpetrators for abuse?

• SOCIOECONOMIC STATUS; mainly from stress but can be any income

• Gender/age; higher risk with YOUNGER PARENTS

• Caregiver with MENTAL HEALTH problems

• Caregiver with DRUG/ALCOHOL usage

• Domestic violence in the HOME

• Child is PREMATURE/MEDICALLY COMPLEX/CHRONIC ILLNESS

• PARENTAL HX of abuse (exposure)

• Caregiver HX of ANIMAL CRUELTY

What are the RISK FACTORS for abuse?

• Detailed hx

• Physical exam

• DX studies

• LOOK FOR RED FLAGS

• LOOK FOR INJURIES/PATTERNS

What are the ASSESSMENTS for recognizing child abuse?

• Hx given DOES NOT EXPLAIN the injury (mechanism of injury does not match), no hx offered, or hx changes over time (changing story)

• Child REPORTS injury done by parent

• Child AFRIAD to go home

• MULTIPLE injuries, various stages of bleeding

• DELAY in seeking medical attention

• Child DEVELOPMENTALLY NOT CAPABLE or would not reasonably be expected to have acted as described

• Child gives UNBELIEVEABLE EXPLANATION (making it up out of fear)

• Serious injury BLAMED on another child

What are the RED FLAGS for recognizing child abuse?

• BRUISES

  • STRANGULATION

• BITE MARKS

• FRACTURES

• BURNS

  • SCALD

  • CONTACT

  • OTHER (electrical, chemical, solar)

• ABUSIVE HEAD TRAUMA (AHT)

  • RETINAL HEMORRHAGE

What are the types of INJURIES from abuse?

BRUISES

What is the MOST COMMON type of physical abuse and MOST LIKELY TO BE MISSED?

• Buttocks/genitalia

• Ears

• Cheek

• Front torso

• Back

• Neck

• Back of legs

• Genital

Accidental usually occurs in knees, shins, elbow, forehead

Which injury locations should make the nurse suspect physical abuse rather than accidental injury?

• Belt buckle

• Belt

• Looped cord

• Stick/whip

• Fly swatter

• Coat hanger

• Board or spatula

• Hand/knuckles

• Bite

• Sauce pan

• Paddles

• Hair brush

• Spoon

What are the patterns of brusing to look out for?

• Trunk

• Ears

• Neck

• 4 years or younger, any brusing on a child <4 months

• Frenulum (head)

• Auricular area (hearing)

• Cheek

• Eyes

• Sclera

• Patterned bruising

What are the TEN 4 FACESp for bruising in abuse?

• Bruising on neck

• Petechiae on face or eyes

• Difficult breathing

• Difficult swallowing

• Hoarseness or changes in voice

• Neck pain or tenderness

What are the S/S strangulation?

• Semi circular or oval

• <2.5CM VS. 2.5-3.5CM (measure from top incisor to lower incisor)

What are the S/S for bite marks in abuse?

• <3 yr old: 24% of fractures in children are INFLICTED

• 80% of abusive fractures occur in children <18 MONTHS

• Bones are more porous (malleable) in younger children and require more pressure to break

What are the AGES of fractures in abuse?

• Skull

• Humerus (spiral)

• Femur (spiral)

• Tibia

• Ribs

What are the most common INFLICTED fractures?

¼

Up to what number of physical abuse if caused by some type of burn?

• Irregular boarders

• Splash burns

What are the common ACCIDENTAL marks of burns?

• Symmetrical injury

• Clear lines of demarcation (well-defined edges)

• Unusual area

• Immersion burns

• Buttocks, perineum, genital

What are RED FLAGS of burns in abuse?

Scald burns

Thick liquids maintain heat much longer, more extensive burn

Spash or spill

What is a typical accidental SCALD burn?

Burn with well demarcated margins

What is a typical inflicted scald burn?

Contact burns

Burns made by touching heated objects

• LOOK FOR PATTERN (stove, cigarette, iron, curling iron)

• Well defined margins

• Location is revealing

What should you look for in contact burns if you suspect abuse?

USUALLY IN THE CONTEXT OF INADEQUATE SUPERVISION OR NEGLECT

When do electrical, chemical, or solar burns happen in abuse?

Abusive head trauma (AHT)

INFLICTED INJURY TO THE HEAD AND ITS CONTENTS including those caused by both SHAKING and BLUNT impact

• Shaken baby syndrome is one form of it

• 70% perpetrators are MALE

• 25% babies die; 90% have lifelong DISABILITIES

Often in children <2 YEARS, average age is 3-8 MONTHS

At what age does AHT happen?

CRYING

What is the #1 TRIGGER for AHT?

Head in infant = 25% body weight, weak neck muscles, high water content in brain

1. Veins in brain are stretched, exceed elasticity

2. Tear, causes bleeding

3. Brain strikes skull

4. Immediate swelling (obstruct ventricles)

What is the PATHO for AHT?

Eyes; RETINAL HEMORRHAGES (back of eye, shows bleeding and swelling in brain)

What is the 1st sign of AHT?

BRAIN DAMAGE; has areas of brain loss → lifelong disabilities

What is the COMPLICATION in AHT?

Sexual abuse

Involvement of adults, older children or adolescents in sexual activities with children who CANNOT GIVE APPROPRIATE CONSENT and who do not UNDERSTAND the significance of what is happening to them

• They TELL YOU they’ve been sexually abused

• Injury to the GENITAL area

• SEXUALLY TRANSMITTED DISEASE

• PREGNANCY

• Child REPORTS/ENGAGED in inappropriate SEXUAL BEHAVIOR (something they learned)

What are the signs sexual abuse might be happening?

Act of OMISSION; failure to provide adequate clothing, nutrition, shelter, medical care, dental care, supervision, education

• Abdandonment

• May be chronic or acute

What is neglect?

• 30% child abuse deaths from neglect

• 64% neglect is a contributing factor

• 70% deaths occured in children <3 yr old

What are the percentages of deaths that happen from neglect?

• MEDICAL neglect (includes DENTAL neglect)

• DROWNING (no splashing)

• Motor vehicle CRASHES

• Children left UNATTENDED in VEHICLES

• CO-SLEEPING; unsafe sleeping

• FIREARMS

• DRUG-endangered children

What are the types of neglect?

• Alone

• Back

• Crib

What are the ABCs of infant safe sleep?

Emotional abuse

• A repeated pattern of damaging interactions between parent(s) and child

• Involves words, actions, and indifference

• Constantly reject, ignore, belittle, dominate, and criticize child

• Child repeatedly feels unloved, unwanted, worthless

• Lack of attachment

• Lack of responsiveness to environment

• Failure to thrive

• Child discloses repeated pattern of emotional abuse

What are the signs emotional abuse might be happening?

ANY PERSON who knows, or has reasonable cause to suspect that a child is abused, abandoned, or neglected by a parent, legal custodian, caregiver, or other person responsible for child’s welfare

• SHALL report such knowledge to the department

• 1-800-96-ABUSE or online

Who is responsible for reporting child abuse?

• Provide name, work address and phone number

• Provide child’s name, age, race, sex, DOB

• State your concern for child’s safety and what type of abuse is taking place

• If possible, give names of siblings

• Provide parent/caretaker information

• Request name and ID number of hotline counselor

How do you report child abuse?