Child abuse and maltreatment is not limited to a particular age—it can occur in the infant, toddler, preschool, and school-age years. Choose one of the four age groups and outline the types of abuse most commonly seen among children of that age. Describe warning signs and physical and emotional assessment findings the nurse may see that could indicate child abuse. Discuss cultural variations of health practices that can be misidentified as child abuse. Describe the reporting mechanism in your state and nurse responsibilities related to the reporting of suspected child abuse. 

There a scores of resources available to the nurse designed to better identify possible abuse, whether it be physical or emotional. When considering possible signs of abuse or mistreatment, the nurse should recognize acute changes in the child’s behavior or patterns. According to the Child Welfare Department, a federally funded and mandated agency (Child Welfare Department, 2019), indicators that interventions may be needed are a decline in a child’s school performance. This may be related to lack of concentration as the child may withdraw as a sign of their own assessment of the degree of safety present in engaging and/or participating in contact with peers or authority figures outside of the home. Excessive absences may be attempts to allow time for healing of results of physical abuse such as abrasions, bruises, or fractures. Reluctantly to go home after school may also be an indicator of possible abuse.  

Abuse goes beyond the physical nature. Emotional abuse has just as long lasting effects on school age children as physical abuse does. School age children are at a stage in their life where they desire to fit in with their peers, notice differences between themselves and other children, and may need assurance that abuse is not their fault (Falkner, 2018).   

References  

Child Welfare Information Gateway (2019). What is child abuse and neglect. Retrieved from https://www.childwelfare.gov/pubpdfs/whatiscan.pdf  

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Falkner, A. (2018). Grand Canyon University (E.D). Age-Appropriate Approach to Pediatric Health Care Assessment. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/chapter/2.  

Response 

You have provided an in-depth post and I agree with you. Ideally, child abuse and maltreatment is associated with devastating effects on children (Gonzalez et al., 2021). As such, it is important to report any case of child abuse. As mandated, nurses are trained to recognize signs and symptoms of child abuse or maltreatment and report to the relevant authority. Failure to report may lead to legal actions against them or disciplinary actions by their employers or board of nursing. If a nurse infers abuse or maltreatment, the first step is to report to the physician, nurse managers, or physician assistant. If the victim is presented to the facility with the alleged perpetrator, the assessment should be done without the perpetrator in the room. A comprehensive head-to-toe examination should be conducted to identify physical signs of abuse. It is essential to have a witness if possible.  Nurses should ensure a comprehensive documentation and description of the findings, non-verbal behaviors, victim statements, and the statements and behaviors of the alleged perpetrator. The law enforcement should be notified instantly while the victim is still in the facility. Moreover, Child Protective Services should be called and followed up with a documented report (Lee & Kim, 2018).  

References 

Gonzalez, D., Mirabal, A. B., & McCall, J. D. (2021). Child abuse and neglect. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK459146/ 

Lee, H. M., & Kim, J. S. (2018). Predictors of intention of reporting child abuse among emergency nurses. Journal of pediatric nursing, 38, e47-e52. https://doi.org/10.1016/j.pedn.2017.10.007 

According to Centers for Disease Control and prevention (CDC), child abuse and neglect is any act or series of acts of commission or omission by a parent, caregiver or another person in custodial role that results in harm, potential for harm or threat of harm to a child and it is preventable. Child abuse can occur in any age group usually the abusers are the nearest and dearest. Neglect, emotional, sexual and medical abuse are some of the abuses faced by infants. This age group is very prone to abuse because it is still very young and solely depends on the parents or caregiver and can not voice their concerns. Abusive head trauma , also known as Shaken head syndrome (SHS), is the worst form of abuse experienced by this population when a caregiver shakes the infant. The baby may experience trauma due to direct blow, when thrown to the ground or surfaces. This results in severe brain and neck injuries that may be irreversible and possibly death. Upon examination of the infant, lethargy or decreased muscle tone, poor feeding/suckling or vomiting for no cause, decreased level of consciousness or seizures are all cues to Abusive Head Trauma just to mention a few (Green S.Z,2018). 

Several cultures today use folk remedies to treat various ailments. Moxibustion is the burning of rolled pieces of moxa herb (mugwort or Artemisia vulgaris) over the skin above acupuncture points and burns till start to feel pain. This is an Asian cultural practice for a variety of symptoms like fever and abdominal pain. The lesions from moxibustion look like a pattern of discrete, circular, target-like burns that maybe mistaken with cigarette burns from child abuse. 

It is the nurses` duty to report any form of suspected child abuse. They are mandated reporters and should not assume that their colleagues will do the reporting. The supervisor is informed of any suspected case and law enforcement agents are engaged as well as the local county Department of Social Services: Child protection services. 

References: 

Child Abuse and Neglect Prevention 

Green S.Z. (2018) Health Assessment: Foundation For Effective Practice 

Cultural Practices-Suspected Child Abuse 

hhtps://www.visualdx.com/visualdx/diagnosis/cultural+practices?diagnosisld=54451&moduleld=43 

Response 

This is an exception post on infant abuse and maltreatment. Other than the physical abuse to infants whose signs can easily be recognized, infants also suffer emotional abuse. Emotional abuse occurs when infants are treated in ways that traumatizes and compromises their normal development (Zeanah & Humphreys, 2018). Signs and symptoms of emotional abuse include demonstration of behavioral problems or changes such as avoiding a parent’s affection, acting depressed or agree, and becoming more clingy. They also display extremes in behavior. The infants may also be delayed emotionally and physically, talk and walk later than usual, or continue to show frequent temper tantrums (Kumari, 2020). However, children often develop at varying rates and sometimes it is challenging to establish whether the delays in development are associated with the abuse. Other signs and symptoms of emotional abuse include stopping communicating almost completely or demonstrating signs of speech disorders. Moreover, a usually assertive and sociable child turns abnormally passive and compliant, while a normally mild child could act in aggressive and demanding way (Buisman et al., 2018).  

References 

Buisman, R. S., Pittner, K., Compier-de Block, L. H., van den Berg, L. J., Bakermans-Kranenburg, M. J., & Alink, L. R. (2018). The past is present: The role of maltreatment history in perceptual, behavioral and autonomic responses to infant emotional signals. Child abuse & neglect, 77, 23-34. https://doi.org/10.1016/j.chiabu.2017.12.020 

Kumari, V. (2020). Emotional abuse and neglect: time to focus on prevention and mental health consequences. The British Journal of Psychiatry, 217(5), 597-599. https://doi.org/10.1192/bjp.2020.154 

Zeanah, C. H., & Humphreys, K. L. (2018). Child abuse and neglect. Journal of the American Academy of Child & Adolescent Psychiatry, 57(9), 637-644. https://doi.org/10.1016/j.jaac.2018.06.007 

Child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence, and commercial or other exploitation, which results in actual or potential harm to the child’s health, survival, development, or dignity in the context of a relationship of responsibility, trust, or power. (World Health Organization, 2020). Neglect is the most common type of abuse for school-age years children (5-12 years old), followed by physical abuse, sex abuse, and psychological abuse. 

As part of a comprehensive exam or holistic assessment, nurses must also assess for signs and symptoms of abuse (Falkner, 2018). Signs of physical abuse include bruising, welts, or burns that cannot be sufficiently explained; unusual bruising patterns such as belt, wire hanger, hand, and so on; injuries on the body where children usually do not get hurt; burns that are insufficiently explained such as cigarette burns; absence of hair or hemorrhaging beneath the scalp due to vigorous hair pulling; fearful or withdrawn behavior. Signs of possible neglect frequently include absence from school; has not received help for physical or medical problems brought to parent or caregiver’s attention; begging or stealing food or money; dirty and has severe body odor; lacks sufficient clothing for the weather; caregivers show little concern for the child or seems apathetic. Signs of possible sexual abuse include difficulty walking or sitting; pain or itching in the genital area, stained or bloody underclothing; bruises or bleeding in external genitalia; frequent complaints of stomachaches or headaches; venereal disease or pregnancy; chronic depression; inappropriate sex play or premature understanding of sex; poor self-esteem or lack of confidence (Mass.gov, n.d.). 

Many cultures use folk health remedies to treat various illnesses, which often result in the appearance of child abuse. Distinguishing child abuse from cultural practices can be a difficult task. Cultural healing practices, including coining (caogio), cupping (hijama), guasha, moxibustion, caida de mollera and certain birthmarks, (Mongolian spots) may present in a manner that suggests child abuse. To ensure an accurate differential diagnosis, the importance of being culturally sensitive and aware of specific belief systems and practices of cultural groups is underscored (Killion, 2017). Nurses need to understand cultural practices, gather an appropriate cultural history from assessment to avoid misdiagnosis and prevent further trauma. 

Certain professionals such as doctors, nurses, teachers, police officers, and child care center workers are mandated by New York State law to report suspected child abuse and neglect to the state hotline, the New York State Central Register (SCR) (City of New York, n.d.). Nurses who fail to report child abuse may result in discipline by the board of nursing and employer. It may be possible legal action was taken against them. When nurses suspect child abuse or maltreatment, they should notify their supervisor, report it to the physician, case managers depending on their facility police. The team should contact additional resources, such as social service and child protective services, to help the victim; call 911 for necessary. 

References. 

City of New York. (n.d.). Mandated Reporters. Retrieved from https://www1.nyc.gov/site/acs/child-welfare/mandated-reporters.page 

Falkner, A. (2018). Grand Canyon University (E.D). Age-Appropriate Approach to Pediatric Health Care Assessment. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/chapter/2. 

Killion, C. L. (2017). SciMed Central. Cultural Healing Practices that Mimic Child Abuse. Retrieved from https://www.jscimedcentral.com/Forensic/forensic-4-1042.pdf 

Mass.gov. (n.d.) Warning signs of child abuse and neglect. Retrieved from https://www.mass.gov/info-details/warning-signs-of-child-abuse-and-neglect 

World Health Organization. (2020). Child maltreatment. Retrieved from https://www.who.int/news/item/29-10-2018-more-than-90-of-the-worlds-children-breathe-toxic-air-every-day 

Response  

This is an outstanding work. In concurrence, abuse for school-age children can affects all aspects of development including psychological, physical, behavioral, emotional, and social aspects (Assed et al., 2020). As a result, the children are likely to suffer dire consequences. Children exposed to abuse are likely to experience interpersonal and attachment problems with their peers and family members. Attachment problems damage the normal development process and affect the ability of children to social and communicate with others and develop strong relationships in their entire lives (Waldron et al., 2018). The other consequence is development and learning problems. There is a strong connection between child abuse and learning challenges and poor academic outcomes. Maltreated children tend to have lower educational success compared to other groups of children. Moreover, children abused in the initial years of life tend to demonstrate poor developmental capacities, especially in vital areas such as speech (Toth & Manly, 2019). Other consequences include mental health issues such as post-traumatic stress disorder (PTSD), suicide ideation, behavioral problems, and violence, aggression, and criminal activity.  

References 

Assed, M. M., Khafif, T. C., Belizario, G. O., Fatorelli, R., Rocca, C. C. D. A., & de Pádua Serafim, A. (2020). Facial emotion recognition in maltreated children: A systematic review. Journal of Child and Family Studies, 29(5), 1493-1509. https://doi.org/10.1007/s10826-019-01636-w 

Toth, S. L., & Manly, J. T. (2019). Developmental consequences of child abuse and neglect: Implications for intervention. Child Development Perspectives, 13(1), 59-64. https://doi.org/10.1111/cdep.12317 

Waldron, J. C., Scarpa, A., & Kim-Spoon, J. (2018). Religiosity and interpersonal problems explain individual differences in self esteem among young adults with child maltreatment experiences. Child abuse & neglect, 80, 277-284. https://doi.org/10.1016/j.chiabu.2018.03.023