Child Abuse

1. Child Abuse Elisa A. Mancuso RNC, MS, FNS Professor of Nursing

2. History Greeks- sacrificed to god England children worked as chimney sweeps. America children worked as coal miners.

3. Mary Ellen Case 1874 First documented abuse case Beaten and abandoned by mother left hours in closet Etta Whealer social worker brought case to ASPCA Led to Society for Prevention of Cruelty to Children (SPCC)

4. Dr. Kempe 1962“The Battered Child Syndrome” Identified specific symptoms of abuse Many bruises & old fractures on x-rays Urged MD’s to report suspected child abuse Lead to professional and public awareness of child abuse and neglect in the US.

5. Dr. Fontana 1963 “The Maltreatment Syndrome” Identified children deprived of food, clothing, shelter and parental love. Children not attaining appropriate growth & developmental milestones. No underlying pathological factor.

6. The Child Abuse Prevention and Treatment Act 1974 Provided federal funding to help fight child abuse 2008 Statistics 3.5 million alleged abused or neglected 905,000 actual victims 64.1 % Neglect 16 % Physical 8.8 % Sexual 6.6 % Emotional 2.2 % Medically Neglect 1,710 died= 4 children/day!! One child every 10 seconds being abused!! www.ocfs.state.ny.us/main/cps

7. Who are the abusers? 48 % male 52 % female 84 % being abused by parent 41 % MOTHER 19 % FATHER 17 % Both PARENTS

8. Abused Child Child <18 years of age. Whose responsible adult- Inflicts non accidental physical injury Creates risk of physical injury Creates risk of emotional health Commits or allows a sexual offense against child Has potential for abuse Substance Abuse

9. Maltreated or Neglected Child Child <18 years old Whose responsible adult: Fails to provide the minimum degree of basic needs. Example: Inadequate food, shelter or Abandoned child.

10. Emotionally Neglected Child Child <18 years old Failure to meet the child’s needs for affection, attention and nurturing. Failure to Thrive (FTT) < 10th % in height and weight with no organic cause. Verbal abuse- “You’re stupid” Kids can be aggressive and impulsive, or have feeding disorders

11. Abusive Adult May have been abused or neglected as a child. A MAJOR RISK FACTOR Learn aggression is appropriate. Difficulty controlling impulses and forming attachments

12. Substances Abuser Primary concern is habit Little or no concern for children. Drug use decreases inhibitions and impulse control Increase in illegal activity Stealing or Prostitution Involve children in prostitution and pornography.

13. Social Isolation Lack of emotional support. Low self esteem. Moves residence frequently. Distrust others

14. Life Crisis Multiple stressors/inadequate coping mechanisms. Single parents ↑↑ Responsibility for sole parent. Teenage pregnancy “Babies having babies” Parents immature and fewer resources. Homelessness

15. Knowledge Deficit View child as miniature adults. Absence of Child Nurturing Experience Parent had no loving relationship Expects baby to provide love. Violence and corporal punishment is accepted as discipline. Parents view child as bad or evil.

16. Unrealistic Expectations Limited knowledge Unrealistic expectations of appropriate developmental milestones Preemies and disabled children are @ high risk for abuse Secondary to ↑ and constant care.

17. Signs of Physical Abuse Bruises- Various stages of healing. Bilateral and generalized. Unilateral are usually with accidents. Clustered patterns reflect objects used: Belt, hand, spoon, wire Face, mouth, lips, torso, back, palms, buttocks, thighs, soles of feet

18. Lacerations Mouth, lips, gums- oral sex Laceration of frenulum could be from forcing bottle in mouth or penis. External genitalia, penis, vagina, anus

19. Burns Cigarettes circular and evenly shaped. Hot water submersion “Sock like or Glove like” burn No splash marks. Stun gun circular and uniform 0.5cm.

20. Fractures Multiple fractures in various stages of healing. Spiral fracture = Red Flag! Old rib fractures/skull fractures. Dislocation of shoulder/elbow.

21. Head Injuries Hair pulling-bald patches. Shaken Baby Syndrome Whiplash from shaking Subdural hematoma Meningeal tear Retinal hemorrhage Seizures Death

22. Poisoning Intentional giving harmful substances: Crack, cocaine, MDMA or alcohol. Unintentional – Free Access (Neglect) Munchausen Syndrome by Proxy Parent fabricates illness of child Gains attention & viewed as concerned Signs of illness only occur when parent in room.

23. Behavioral Signs Social Isolation. Apprehension. Emotional lability

24. Sexual Abuse 2008 80,000 episodes/year (under reported) Incest Molestation Rape Child Pornography Child Prostitution Higher incidence with females High risk with father, family member or male friend Rare for a stranger

25. Physical Signs of Sexual Abuse Sore throats Vaginal infections Bruises on hard/soft palate Incontinence Pain itching genital area Torn stained bloody underwear Loss in rectal tone Non-intacthymen in females

26. Behavioral Signs of Sexual Abuse Reluctant to change in gym class Self mutilation Excessive masturbation in young child Withdrawal Promiscuous behavior. Alcohol/drug use Eating disorders Suicide Attempts Regressive behaviors Severe mood swings

27. Nursing Interventions Provide privacy Separate from parents Maintain safe environment Monitor Verbal & Non-Verbal Cues! Identify child’s words for genitals Provide opportunity to talk Abuse is not their fault Reinforce that telling someone was right thing to do

28. Report Procedure Report Phone # 1-800-635-1522 (State Central Register) 1-800-342-3720 (CPS hotline) Immediately notify charge nurse/supervisor or can report independently. First oral report Submit written report DSS-2221A in 48 H. (Nursing supervisor or MD does this with local CPS.) Report is admissible in court

29. DSS-2221A Report RN is mandated reporter. Class A Misdemeanor Failure to report suspected child abuse/maltreatment Make report clear, objective and accurate.

30. History of Injury Date, time and place Sequence of events Describe parent and child interactions Are they appropriate? Who does child reach out to? Presence of witnesses. Interview with child and parent individually. Congruent reports?

31. Physical Examination SANE (Sexual Assault Nurse Examiner) Anatomical location of injury Size, shape and color of distinguishing marks. Pain or bone tenderness and ROM. State of health and hygiene Appears malnourished/unkempt

32. Documentation Pictures Date, time, pt name, med record #. X-rays Clothes Note if torn, body fluids or bloody Do not remove from the child if possible Lab reports Chain of custody must be maintained.

33. Actions taken What was done? If child admitted to hospital and CPS notified and will be involved. Where was child placed? Relative’s home or foster care. Who was notified? Name of case worker and case number to be placed on chart. CPS must complete investigation in 60 days.

34. Protective Custody Temporary removal for imminent danger. No ample time to approach courts. Only by authorized persons; Police, SPCC Agent, Social Worker or Hospital administrator. Transport to official agency housing. Notify parent with written notice of where child was placed.