In 2011 there were 34 million reports of child abuse which included an estimated 62 million children in the United States Each day 10000 children are abused molested or tortured amp 5 of those children will die from the abuse ID: 337155
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Slide1
Nursing Care of the Maltreated ChildSlide2
In 2011, there were 3.4 million reports of child abuse which included an estimated 6.2 million children in the United States.
Each day 10,000+ children are abused, molested, or tortured & 5 of those children will die from the abuse.
93% of abused children are abused by someone they know and trust.
The estimated cost of care related to child abuse in this country alone is $124 billion dollars!Slide3
What is Physical Abuse?
“The deliberate maltreatment of another individual that inflicts pain or injury or may result in permanent or temporary disfigurement or even death.”Most common types of child abuse:
Hitting, slapping, kicking, or punchingWhipping with belts, shoes, cords, etc.Inflicting burnsImmersing child or body part in scalding water
Shaking
Tying the child to the bed or other object
Throwing the child against a wall, down the stairs etc.
Choking or gaging the child
Deliberately administering excessive doses of drugsSlide4
Risk Factors
Age under 3 years
Parent was abused as a childSpousal abuseIsolated from family or friends
Chronic illness
Stress in families
Stepparents or paramour in household
Drug or alcohol abuse
S
ocial /
economic groupSlide5
Risk Factors
History of mental illness, domestic violence, incarceration, or substance abuse
Inadequate childcare or supervisionInadequate familial support
Access to firearms
High exposure to media violence
If child has ADHD or other developmental behavioral issues
Use of corporal punishment or other inappropriate “discipline” methodsSlide6
7 Deadly Sins of Childhood:
Colic / incessant crying
Awakening at nightSeparation anxietyNormal exploratory behavior
Normal negativism
Poor appetite
Toilet training resistance or accidentsSlide7
Red Flags
Injury is not congruent with description of incident or developmental level of child
Stories not consistentDelay in seeking care for a significant injurySlide8
Clinical Manifestations
Multiple bruises in various stages of healingScald burns with clear lines of demarcation and a in a glove or stocking distribution
Rope, belt, or cord marks, usually seen on the mouth, butt, back, legs, and armsBurn scars in various stages of healing Multiple fractures in various stages of healingSpiral fractures not explained by accidentShortness of breath and distress upon being moved
Cranial injuries
Abdominal injurySlide9
Other Suspicious Findings
Human Bite Marks
Marks and / or Scratches
Missing HairSlide10
Other Suspicious Findings: Burns Slide11
What If You See This?Slide12
What If You See This?
6 year old boy comes into the ER with right leg pain after reportedly falling down. This is what the x-ray showed:
Is this abuse? Slide13
Shaken Baby Syndrome
Caused by shaking an infant or child
10-12% of deaths from abuse1/3 survive with no problems1/3 suffer permanent damage
1/3 die
Often crying is the precipitating factorSlide14
http://www.youtube.com/
watch?v=THhFoYk7U40 Slide15
Infant Anatomy
Underdeveloped bone
+
Underdeveloped tissue
+
Underdeveloped neck
=
Increased risk for:
Brain Damage
Cerebral Hemorrhages
Cerebral Blood Clots
Retardation
Neck / Spinal Injury
Paralysis
Blindness & Deafness
DeathSlide16
Shaken Baby SyndromeSlide17
Clinical Manifestations of SBS
Often no external signsSubdural hemorrhage
Retinal hemorrhagesApnea, seizuresVomiting
Irritability
P
oor suck / swallow / breathe, poor feedingSlide18
Retinal HemorrhagesSlide19
Sexual Abuse
“The exploitation of a child
for the sexual gratification of an adult.” “A child is anyone who has not reached the age of consent, EVEN IF A TEENAGER.”
1 in 3 girls and 1 in 6 boys will be sexually abused by their 18
th
birthday.
The average age of children when they are sexually abused is 4 years.
Most common abuser is the child’s parent or guardian, a male friend of the child’s mother, or another family members or friend.Slide20
Risk Factors in Adults
Addiction, poor impulse control, low self esteem, other personality disordersPoor parenting experiences Marital stressorsEnvironmental stressors
Social isolationInappropriate expectations for the developmental level of the childSlide21
Sexual Abuse: Clinical Manifestations
Vaginal dischargeBlood-stained underpants or diaperGenital redness, pain, itching, or bruising
Difficulty walking or sittingSleeping problemsBed-wettingUnwillingness to be around someoneUTI
/ STI
Fear of
strangers
Phobias about particular places, people, or
things
New or excessive sexual curiosity or play
Constant masturbation
Curling into fetal positionChild or adolescent female acts like a wife or mother
Excessively seductive behavior
Child or adolescent works as a prostituteSlide22
Sexual Abuse: Clinical Manifestations
Abrupt change in school performance Change in eating habitsAbrupt changes in behavior (withdrawal)Somatic complaints (headache / stomachaches)
These are about what for the child?Slide23
Emotional Abuse
“Involves shaming, ridiculing, embarrassing, or insulting the child.”May include destruction of property or harming, killing, or giving away the child’s pet.Intent of emotional abuse is to frighten or control. Witness to domestic violence? Slide24
Clinical Manifestations
Change in behavior or school performanceFear of avoidance of certain people, genders, or situationsAnger and violent play
Sedation from overmedicationExacerbation of chronic illness d/t withholding of medicationInappropriate clothing for the seasonSlide25
Clinical Manifestations
Poor physical growthFailure to meet appropriate developmental milestones / developmental delaysChild has difficulty relating to adultsImpaired communication skills
Behavioral signs: withdrawn, generalized anxiety, fear, shame, aggression, delinquency, depression; extreme efforts to please Slide26
Munchausen by Proxy
Parent or caretaker fabricates the signs and symptoms of disease
Causes the child unnecessary and potentially harmful medical procedures, illness and disabilitySlide27
Characteristics of Mothers
Appear concerned and attentive / seldom leave child’s sideOffers to asset with care, including specimen collection and meds
Trained in health related fieldIntelligent and articulateAbsent fatherMeets unmet needs for nurturingSlide28
Warning Signs
Bizarre signs and symptoms with no apparent pathological explanation
Symptoms recur or persist despite active managementSigns don’t occur in absence of mother
“Never
seen a case like this before”
Polymicrobial
bacteremia
Seeks care at multiple settingsSlide29
Neglect
Most common type of child abuse but can be hard to determine“Emotional neglect is characterized by the caretaker’s emotional unavailability to the child.”
Cold interactions that lack sensitive personal attention What if the parent is mentally ill, or abusing illegal substances?“Physical neglect
is the deliberate withholding of or failure to provide the necessary and available resources to the child.”
Supervision appropriate to the child’s age
Adequate nutrition and hydration
Hygiene
Shelter
Appropriate healthcare (medical neglect?)Slide30
Child Abuse
Long Term EffectsBased on what we have learned today, what might
some long term effects of child abuse be?Slide31
EricksonSlide32
MaslowSlide33
“Child abuse casts a shadow the length of a lifetime.”
Children who have been abused are more likely to abuse others in their future. This is related to:A long period of abuseUse of violent force or threat of violence
Abuse involving penetration Abuse involving family members, especially the father or stepfather
– Herbert WardSlide34
Nursing Responsibilities
DetectionDocumentationLocation, color, size, shape of any injury
Child’s anxiety level and response to othersStatements made by child/parentReporting: Mandated by law to report suspected
abuse
Always try to remain:
NONJUDGEMENTAL & SUPPORTIVE!Slide35
LISTEN, EDUCATE & RAISE AWARENESS!Slide36
Understand How It Happens
Abuse and neglect in the United States has increased 134% since 1980.Abused children are 6x more likely to abuse their children some day.Abused children are 24x
more likely to commit sexual assault, 74x more likely to commit crimes against others, 50x more likely to abuse alcohol or drugs.
Abused children
are
25% more likely to experience teen pregnancy.Slide37
See if you can ID the risk factors & red flags
Age
Alcoholic Mother
Single Mother
Father as “passive observer” /
inadequate familial support
Isolated
Blisters on palms
of hands and biceps
Mother abused
in past
Physical Signs:
Stabbed
Burn marks
Breathing difficulty?
Under developed Slide38