Consider the possibility of sexual abuse when the parent or other adult caregiver (Child Welfare, 2021) is unduly protective of the child or severely limits the child’s contact with other children, especially of the opposite sex; is secretive and isolated; or is jealous or controlling with family members.
Evidence-based practice Studies have shown that the short- and long-term psychological outcomes of children who have experienced sexual abuse are better if they have supportive parental figures. Parental support is more important than abuse-related factors in predicting psychological recovery (Betchel & Bennett, 2019b).
FACTITIOUS DISORDER IMPOSED ON ANOTHER (FDIA)
● Signs or symptoms begin only in the presence of the caregiver. Clinical improvement occurs when the child is separated from the caregiver. Signs of FDIA The following are the most common signs and symptoms for FDIA (Unal et al., 2017): ● Apnea. ● Anorexia or feeding problems. ● Bleeding, including blood in urine, vomit, or stool.
Factitious disorder imposed on another (FDIA), also known as Munchausen syndrome by proxy , is defined as a “child receiving unnecessary and harmful or potentially harmful medical care because of a caregiver's overt actions, including exaggeration of symptoms, lying about the history or simulating physical findings (fabrication), or intentionally inducing illness in their child” (Roesler & Jenny, 2018). FDIA is also known as medical child abuse and caregiver- fabricated illness in a child. With FDIA, the child receives unnecessary and harmful, or potentially harmful, medical care at the recommendation of the child’s caregiver (Roesler & Jenny, 2018). The essential feature of the condition is the caregiver’s falsification and inducement of physical and/cor psychological symptoms or signs in a child that places the child at potential risk (Roesler & Jenny, 2018). FDIA is relatively rare, but best estimates suggest that nurses and other healthcare professionals will encounter at least one case during their career (Roesler & Jenny, 2018). Based on observational studies, the estimated annual incidence of FDIA is 0.4 to 1.2 per 1,000 children younger than age 16; however, this number is likely underestimated (Roesler & Jenny, 2018). In 2021, there were five allegations of medical child abuse in Pennsylvania, making up 0.1% of total allegations of child abuse (Pennsylvania Department of Human Services Annual Child Abuse Report, 2021). There is no typical presentation of FDIA. Almost every disease category has been implicated in FDIA, and there is a broad range of manifestations (Roesler & Jenny, 2018). Here are general features of FDIA (Roesler & Jenny, 2018): ● The history the parent gives is different than what is observed or does not make sense (e.g., the parent describes serious symptoms in a normal appearing child). ● Histories from different observers vary significantly, suggesting the perpetrator’s history is distorted. ● The illness is recurrent, unexplained, unusual, or prolonged and does not respond to treatment. ● Family history may indicate that the child’s siblings died or have had similar illnesses. ● The child is subject to repeated office visits, multiple diagnostic tests, and medical interventions as well as management by many specialists without improvement of the illnesses.
● Diarrhea. ● Vomiting. ● Seizures.
● Fever. ● Rash.
FDIA includes not only fabrication of physical conditions but also fabrication of emotional and behavioral conditions, including (Roesler & Jenny, 2018): ● Attention-deficit/hyperactivity disorder (ADHD). ● Bipolar disorder. ● Anorexia. ● Allegations of sexual abuse. Healthcare consideration: Many attempts have been made to develop a profile of a typical FDIA perpetrator. The profile includes the following characteristics: Having extensive medical knowledge, exhibiting calm during otherwise stressful medical events, being a medical provider, and becoming angry at medical providers who do not agree with them (Roesler & Jenny, 2018). Although these may be helpful in raising one’s suspicion, they have little predictive value; thus, the nurse should remain focused on the experience of the child rather than the personality of the caregiver (Roesler & Jenny, 2018). Self-Assessment Quiz Question #6 Which of the following is not a common sign or symptom of possible FDIA in a child?
a. Seizures. b. Vomiting. c. Kidney stones. d. ADHD.
HUMAN TRAFFICKING
The key elements of the Trafficking Victims Protection Act (TVPA) indicate it is illegal to use force, fraud, or coercion to exploit a person for profit or for personal services. The use of coercion can be direct and physically violent, or it can be through psychological means. Although most news accounts of human trafficking focus on the violence endured by the victims of human trafficking, the powerful effects of
Human trafficking, at its most basic level, is defined by the Trafficking Victims Protection Act of 2000 as (a) the recruitment, harboring, transporting, supplying, or obtaining a person for labor or services through the use of force, fraud, or coercion for the purpose of involuntary servitude or slavery or (b) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion or in which the person induced to perform sex acts is under 18 years of age.
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