Child abuse and maltreatment is not limited to a particular age and can occur in the infant, toddler, preschool, and school-age years. Choose one of the four age groups (infant, toddler, preschool, or school age) and discuss the types of abuse that are most often seen in this age. Discuss 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. Include in-text citations and references for each of the scholarly sources used. Respond to other learners’ posts in a manner that initiates or contributes to discussion. Child abuse, as defined by the U.S. Child Abuse and Treatment Act, is “any intentional act or failure to act by a parent or caretaker that results in a child’s death, serious physical or emotional harm, or sexual abuse or exploitation” (as cited in Pinto & Schub, 2013, p. 1). Although child victimization can occur at any age, the youngest age group, infants, are the most vulnerable and “are at greatest risk for severe injury and death from abuse” (CDC, 2010, p. 1).
According to the U.S. Department of Health and Human Services (DHHS), “Victims in the age group of birth to 1 year had the highest rate of victimization” in 2011 (DHHS, 2012, p. 11). Their increased vulnerability is due to their small size, inability to defend themselves, and dependability on others for shelter and food. The most common forms of maltreatment seen in this age group, as reported by the DHHS, is neglect, which includes any failure of a caregiver to provide for the child’s basic needs, such as food, shelter, and medical care. In 2011, more than one third of the children who suffered medical neglect were younger than 3, with the most number of children under 18 months of age (DHHS, 2012). Another form of abuse commonly seen among infants is physical. Physical abuse involving children younger than 18 months old accounted for the most number of physical abuse cases reported in 2011 (Pinto & Schub, 2013). For example, Shaken Baby Syndrome, also known as Abusive Head Trauma, is a form of intentional physical injury to infants inflicted by forcible shaking, with or without hard surface impact, which can result in severe head trauma, causing injury to the brain (Hoyle & Frey, 2011). In 1972, Dr. John Caffey, a pediatric radiologist, was first to theorize that “shaking infants could cause them to have intracranial hemorrhaging” (Seeley, 2011, p. 2328).
In the follow-up study, he concluded, “the presence of subdural and retinal hemorrhaging alone, even without any signs of external trauma could be sufficient to diagnose child abuse” (Seeley, 2011, p. 2321). Today, it is recognized as the most common cause of infant physical abuse fatalities and long-term disability, making abusive head injuries among infants a devastating form of child abuse. Although the percentage of injuries as a result is not currently known, the American Academy of Pediatrics estimates there are between 600 and 1400 cases in the U.S. each year (Hoyle & Frey, 2011). Research often cites excessive crying “as the trigger that causes exhausted or frustrated parents to shake their babies” (Barr, 2007, p. 4). In fact, new evidence suggests that crying is indeed the most common trigger (Barr, 2007). Therefore, equipping parents with coping strategies may help reduce the incidence of shaken baby syndrome. Barr (2007) notes that “prevention programs should focus on improving parents’ understanding of the unique properties of early crying” (p. 4). Increasing evidence shows that inconsolable and prolonged bouts of crying, “are likely to occur regardless of the soothing methods used” (Barr, 2007, p. 4) and in 95% of the cases, this is a normal part of healthy infant development. Thus, Barr (2007) suggests that parents who are aware of this may get less frustrated if they know it will pass.
As stated in Pinto & Schub (2013), premature and/or colicky infants are at high risk for physical abuse. Moreover, infants are preverbal, which makes assessment and intervention especially challenging. Nonetheless, healthcare professionals must look out for warning signs. Some red flags may be raised as early as the baby’s birth. For example, poor mother-infant bonding from birth has been identified as a high risk for possible abuse later on and “may be caused by the delivery of a preterm infant, multiple infants, or one with a disability who has a prolonged stay in the hospital” (Lyden, 2011, p. 2). In the cases of inflicted brain trauma, abuse can sometimes be difficult to diagnose because the baby may not have any external marks, other than bruises on chest and extremities from where the infant was held (Lyden, 2011). Researchers say that retinal hemorrhages in infant’s eyes should be considered as signs of abuse until proven otherwise, although they acknowledge that retinal bleeding in infants can be caused by other conditions, those conditions can be ruled out through history, physical exam, and labs (Lyden, 2011). Child abuse crosses all ethnic racial, cultural, and socioeconomic lines. According to Ramen & Hodes (2012), in today’s multicultural society, healthcare professionals are often faced with the challenge of “exploring and resolving the tension between definitions of harm in child protection practice and various cultural and child-rearing practices” (p. 30). For example, many cultures accept physical punishment as a form of discipline, which is the most common cause of cross-cultural clashes (Ramen & Hodes, 2012).
Moreover, “some cultural practices used to treat illness produce petechiae and purpura that can mimic abuse” (Harris, 2010, p. 216). An example of such practice is “coining” or “cupping”, which both produce marks on the skin. However, bruises produced by these practices result in a symmetrical pattern, which is often an uncommon finding in child abuse. In addition, bruises in very young infants, at any location, are uncommon, especially without a known medical condition, and should raise suspicion of child abuse (Harris, 2010). Cultural values and beliefs also influence how one perceives child abuse, which, in turn, influences whether he/she reports or intervenes in an abusive situation (Harris, 2010). As mandated reporters, nurses in all 50 states are obligated, both ethically and legally, to report suspected child abuse. The failure to report is a crime in itself. In New York State, beginning October 1, 2007, mandated reporters who have reasonable cause to suspect child abuse, must personally make a report to the Statewide Central Register of Child Abuse and Maltreatment. They must then immediately notify the person in charge of the facility where they work that a report has been made.
