Child Abuse

Child abuse is a prevalent social issue and can be in the form of physical, emotional, sexual, or neglect of the caregivers or parents in meeting the needs of the child. While the issue may not be outwardly spoken, Moylan, Herrenkohl & Sousa (2010) note that in 2006 research indicated that about 900,000 children received maltreatment from their parents and caretakers. Essentially, child abuse is associated with a plethora of somatic and psychological problems with actual or potential harm to the children sometimes lasting throughout their lifetime (Bailhache, Pillet & Leroy, 2013). Care providers and especially nurses have a crucial role in detecting abuse and intervening in child abuse, because of their constant contact with infants. In light of this, we seek to analyze data provided by a case study to identify potential markers of abuse, explore the risks, and consider the professional responsibility of nurses in caring for vulnerable infants and children.

Emma is a 3-month-old girl brought in by her mother to the Emergency Department, with a 12-hour history of vomiting and lethargy for examination. During the investigation, it is evident that Emma has difficulties staying awake as the nurse takes her vital signs. Her torso has several small, oval shaped bruises as well as the back of her head. Emma’s mother is vague when asked how her children acquired the injuries, citing a roll off the couch last night. Before completing the examination, the girl has a seizure and is transferred to the resuscitation unit. Within the contexts of potential markers of abuse, this case study provides a descriptive experience of children who suffer child abuse in the hands of their parents or caretakers. According to (), sustained maltreatment can have several major and long-term effects on all aspects of a child’s health and well-being. 

Impacts of Child Abuse

The link between child abuse and adverse health outcomes on their health and well-being is well established. Child abuse has been linked with numerous devastating effects ranging from physical, psychological, cognitive, and behavioral. Essentially, the consequences of physical injury range from minor injuries to severe brain damage and sometimes death (Majer, Nater & Lin, 2010). As it is Moran, Findley & Barnes (2012) note that, a child does not need to be beaten on the head to sustain injuries, sometimes vigorous shaking by the extremities can lead to internal brain damage that is hard to detect on the outside. Similarly, abuse and neglect may result in serious health problems including significant neuromotor handicaps, physical defects, mental retardation, and sometimes speech problems.

Within the clinical settings, cognitive consequences emanating from child abuse range from attention problems, learning disorders to severe brain syndromes. Studies show that abused or neglected children who do not display signs of neurological impairment are likely to have delayed intellectual development especially in their verbal intelligence leading to lowered mental and cognitive functioning (Spratt, Friedenberg & Swenson, 2012). In school going children who suffered abuse or neglect, studies show that they are likely to have problems with their performance at school, recording lower grades, frequent grade retention, and poor scores on standardized tests. Along with that, children are also likely to have problems with social-information-processing patterns, which is liable to cause chronic aggressive behaviors. Alongside cognitive consequences, physical aggression and antisocial behavior are some of the most consistently identified outcomes linked to child abuse. According to studies, children who experience abuse during infancy are likely to be incompetent in their interactions with their peers. Mostly, these children manifest signs of withdrawing or avoidance, fear, anger, and sometimes aggression towards their peers.

The immediate emotional effects of child abuse usually translate into fear, inability to trust, isolation, and long-lasting psychological effects including depression, anxiety disorders, and low self-esteem. Federle (2013) notes that during the early stages of neglect, children often display stressful behaviors in the form of feeding problems, irritability, or unresponsive social behaviors that seem to weigh down on the parents or caregivers duties. In most cases, lack of proper nutrition alongside maternal detachment sets into motion a chronology of cumulative psychological risks such as the child may become extremely quiet and display signs of sickness. In addition to the above, young adolescents who experienced maltreatment in their infancy are also likely to be defiant and hostile. Sadly, even after diagnosis and treatment, psychological effects of child abuse persist.

Essentially, there is a significant body of ongoing research about consequences of child abuse and neglect on children. The impacts vary depending on the circumstances, the child environment, and parent characteristics. Consequences vary from mild to severe, with the ability to affect the child for a short period or in their lifetime. Therefore, it is imperative to understand the potential markers of child abuse, to be able to come up with a comprehensive framework for intervention programs to improve the health outcomes and well-being of the child.

Potential Markers of Child Abuse

When investigating child abuse, several complexities challenge the unveiling of potential markers that indicate abusive experiences in children. In fact, a majority of children who have been abused do not display signs of disturbance making it hard for caregivers to obtain indicators, leaving the option of self-report from parents or referrals made to the Child Protective Services (Begle, Dumas & Hanson, 2010). Unfortunately, these methods have several limitations including parent reluctance to admit child abuse or neglect like in the case of Emma. Essentially, in the context of the case study, child abuse usually takes two forms; physical abuse, which is defined as injury afflicted by caregiver, and neglect defined as lack of action from the caregiver. In the case of Emma, the clinical assessment data indicates several small, oval shaped bruises on her torso and the occiput. According to Baz & Wang (2013), distinguishing normal bruises from inflicted injuries in children can be hard. However, recognizable geometric shapes are highly suspicious of inflicted injury. In addition, accidental bruising is more likely to be in areas such as joints, forehead, or the front of the body, but bruises around the truck, eyes, neck, ears, and genitalia are potential markers of abuse. 

Alongside these markers, Emma proves difficult to rouse and does not stay awake when the doctor is taking her vital signs. She was also brought to the hospital with a 12-hour vomiting and lack of inactivity for assessment. Towards the end of the test, she also develops a seizure, leading to her transferred to the resuscitation unit. Although not conclusive, the inability of Emma to stay awake and the fact that she suffered a seizure is an indicator of a possible head injury. Unfortunately, the ability of the caregiver or physicians to distinguish between accidental and abusive head injury is hard and can only be facilitated by a clear understanding of the biomechanics of brain injury. As Baz & Wang note, abusive head injury displays a wide range of symptoms and clinical findings. For instance, children are likely to have less ominous symptoms such as vomiting, lethargy, and irritability. In severe cases, children are likely to experience seizures, altered mental status among other life-threatening signs. Apart from these markers, Emma’s mother is vague about her daughter’s injuries, which points to a critically important need to intervene for Emma and protect her from the situation.

Child abuse is a social problem prevalent in our society. In order to protect children from abuse, nurses must be aware of identifying, reporting, and offering any necessary help for suspected child abuse. The role of a nurse in child abuse extends beyond the realms of legal address in that; nurses are mandated to report such incidences (Lazoritz, 2010). As it is, without reporters of child abuse, a significant link between abuse and child safety is terminated risking the life of thousands of children. As a mandated reporter, the nurse must ensure accuracy when writing the report on the abuse as a way of protecting the child and safeguard their professional status. Similarly, the nurse must be aware of the state laws to have an understanding of the right procedure to report an alleged case of abuse or neglect. In addition to the above, although a majority of the states guarantee anonymity to the person reporting, the nurse has a responsibility to report whether they are covered by anonymity or not. As a point to note, the law indicates that simply reporting to a supervisor or the person in charge does not satisfy the law. If the nurse is the initial reporter, they have a responsibility to follow up with the relevant authority to ensure the child’s safety is assured.

The issue of child abuse is a major public health problem with actual or potential to harm the health of the child, endangers their survival, and slows down their development among others. Child abuse and neglect have several significant consequences on the health of the child, with a possibility of causing death if intervention is not initiated early enough. Consequently, unlike other forms of abuse, child abuse is the most difficult to identify due to several underlying factors such as the inability of the infant to talk and uncooperative parents, who in some cases are the source of the physical injury and neglect. Systematic early detection of abuse could help reduce deaths as well as maltreatment-related morbidity. A necessary coordination is between caregivers, especially nurses and child abuse prevention and treatment agencies. 

References

Bailhache, M., Pillet, P., Leroy, V., & Salmi, L.-R. (2013). Is early detection of abused children possible?: A systematic review of the diagnostic accuracy of the identification of abused children. Bmc Pediatrics, 13(1), pp. 1-11.

Baz, B., & Wang, N.E. (2013). Physical Abuse of Children: Identification, Evaluation, and Management. AHC Media. Retrieved from: https://www.ahcmedia.com/articles/30973-physical-abuse-of-children-identification-evaluation-and-management

Begle, A. M., Dumas, J. E., & Hanson, R. F. (2010). Predicting Child Abuse Potential: An Empirical Investigation of Two Theoretical Frameworks. Journal of Clinical Child & Adolescent Psychology, 39(2), pp. 208-219.

Federle, K. H. (2013). Children and the law: An interdisciplinary approach with cases, materials and comments. New York : Oxford University Press.

Lazoritz, S. (2010). What every nurse needs to know about the clinical aspects of child abuse. American Nurse Today, 597), pp.1-9.

Majer, M, Nater, U M, Lin, J-M S, Capuron, L, & Reeves, W C. (2010). Association of childhood trauma with cognitive function in healthy adults: a pilot study. BMC Neurology,10(61), pp. 1-10.

Moran, D. A., Findley, K. A., Barnes, P. D., & Squier, W. (2012). Shaken Baby Syndrome, Abusive Head Trauma, and Actual Innocence: Getting it Right. Journal of Health Law & Policy, 12(2), pp. 209-312.

Moylan, C. A., Herrenkohl, T. I., Sousa, C., Tajima, E. A., Herrenkohl, R. C., & Russo, M. J. (2010). The Effects of Child Abuse and Exposure to Domestic Violence on Adolescent Internalizing and Externalizing Behavior Problems. Journal of Family Violence, 25(1), pp. 53-63.

Spratt, E. G., Friedenberg, S. L., Swenson, C. C., Larosa, A., De, B. M. D., Macias, M. M., Summer, A. P., … Brady, K. T. (2012). The Effects of Early Neglect on Cognitive, Language, and Behavioral Functioning in Childhood. Psychology (irvine, Calif.), 3(2), pp. 175-182.