Child Maltreatment

CAPTA definition of child abuse

Any act or failure to act by a caregiver that results in harm or risk of serious harm to a child.

Most common type of maltreatment

Neglect.

Mandatory reporter

Healthcare providers, educators, social workers, and law enforcement are legally required to report suspected abuse.

Does reporting require proof?

No; suspicion alone is enough to report.

Good faith reporting

Protects reporter from civil and criminal liability.

First nursing priority in suspected abuse

Ensure child's immediate safety.

Physical abuse definition

Deliberate infliction of physical injury by caregiver.

Neglect definition

Failure to provide basic needs (food, shelter, clothing, supervision, medical care).

Emotional abuse

Behavior that damages a child's self-esteem (rejecting, isolating, terrorizing).

Sexual abuse definition

Use or coercion of a child for sexual activity or exploitation.

Incest

Sexual activity between family members (blood relation not required).

Molestation

Touching or fondling for sexual purposes.

Pedophilia

Adult preference for prepubertal children.

Munchausen Syndrome by Proxy

Caregiver fabricates or induces illness in child to gain attention.

Abusive Head Trauma (Shaken Baby Syndrome)

Violent shaking causing intracranial bleeding and retinal hemorrhages.

Classic signs of Abusive Head Trauma

Subdural hemorrhage, retinal hemorrhages, rib fractures.

Important fact about Abusive Head Trauma

Often no external signs of injury.

Symptoms of Abusive Head Trauma

Irritability, vomiting, seizures, poor feeding, developmental delays.

Physical neglect signs

Growth failure, malnutrition, poor hygiene, inappropriate dress.

Behavioral signs of neglect

Begging/stealing food, absenteeism, substance abuse.

Red flag injury

Injury inconsistent with developmental stage.

Suspicious fracture pattern

Spiral fractures or fractures in different stages of healing.

Patterned bruising example

Handprint, belt mark, looped cord mark.

TEN-4 rule

Bruising to Torso, Ears, Neck in child under 4; ANY bruising under 4 months is suspicious.

Sexual abuse physical signs

Genital bruising, STI, pregnancy, pain with urination.

Sexual abuse behavioral signs

Regression, sexualized play, running away, sudden behavior change.

How to respond to disclosure

Provide privacy, do not promise secrecy, reassure child it is not their fault.

What NOT to do during disclosure

Do not show shock or criticize family.

Documentation rule

Document objective findings and exact quotes from child.

Environmental risk factors

Chronic stress, poverty, social isolation.

Parental risk factors

Substance abuse, young parent, low self-esteem.

Child risk factors

Prematurity, disability, young age.