● The parent/caregiver overtly rejects the child. ● The parent/caregiver is unconcerned about the child and refuses to consider offers of help for the child’s problems.
Self-Assessment Quiz Question #4 Which of the following is true regarding possible signs and symptoms of emotional abuse in a child? a. The child reports a strong attachment to the parent. b. The child shows no extremes in behavior. c. The child is either inappropriately infantile, for example, frequently rocking or head banging, or inappropriately adult, for example, parenting other children. d. The child shows maturity in emotional or physical development. ● The child flinches easily or avoids being touched. ● The child’s play includes abusive talk or behavior. ● The child has unexplained injuries. ● The child has an unbelievable or inconsistent explanations of injuries. ● The child has injuries inconsistent with a child’s age/ developmental level. ● The child is unable to recall how injuries occurred or account of injuries is inconsistent with the nature of the injuries. ● The child has multiple bruises in various stages of healing. ● The child has bruises located on face, ears, neck, buttocks, back, chest, thighs, back of legs, and genitalia. ● The child has bruises that resemble objects such as a hand, fist, belt buckle, or rope. ● The child has burns. ● The parent/caregiver offers conflicting, unconvincing, or no explanation for the child’s injury, or provides an explanation that is not consistent with the injury. ● The parent/caregiver describes the child as evil or in some other very negative way. ● The parent/caregiver uses harsh physical discipline with the child. ● The parent/caregiver has a history of abuse as a child. ● The parent/caregiver has a history of abusing animals or pets. Healthcare consideration: When documenting an encounter with a child with suspected abuse, the nurse should remember that medical records and additional testing are important to assist CPS and police investigations (Christian & Committee on Child Abuse and Neglect, 2015). Evidence-based practice It is important for the nurse to not assume that the child is injury free just because the child does not cry or look upset. In a recent study of accidental fractures in children younger than six years of age, a notable minority of them with long-bone fractures did not cry or use their affected limb abnormally after injury (Christian & Committee on Child Abuse and Neglect, 2015). This caused some delay in seeking medical care (Christian & Committee on Child Abuse and Neglect, 2015).
Physical abuse Physical abuse is defined as "a type of maltreatment that refers to physical acts that caused (or could have caused) physical injury to a child" (Child Welfare, 2021). Physical abuse is intentional physical injury ranging from minor bruises to severe fractures to death (Child Welfare, 2021). Such injury is considered abuse regardless of whether the abuser intended to hurt the child. Physical discipline (spanking or paddling) is not considered abuse as long as it does not cause bodily injury and is considered “reasonable” (Child Welfare, 2021). Physical abuse ranges from minor bruises to severe fractures to death as a result of beating, punching, kicking, biting, throwing, shaking, stabbing, choking, hitting (with a hand, stick, strap, or other object), burning, or otherwise harming a child (Child Welfare, 2021). Soft tissue injuries (bruises, abrasions, and lacerations) are the most common (Boos, 2019a). Head injuries, including shaken baby syndrome, are less frequent but cause the majority of deaths (Boos, 2019a). Burns comprise 14% of physical abuse injuries (Leatherby, 2016). Possible abdominal injuries from physical abuse include blunt injuries from hitting or kicking, liver lacerations, and contusions of the kidney or pancreas (Boos, 2019b). Possible types of fractures can include rib fractures, spiral fractures, and multiple fractures (Boos, 2019a). According to Child Maltreatment 2019, of child abuse and neglect victims in the U.S., 17.5% were physically abused (Child Welfare, 2021). In 2021, there were 1,418 allegations of physical abuse, making up 26.1% of total allegations of child abuse in Pennsylvania (Pennsylvania Department of Human Services Annual Child Abuse Report, 2021). Signs of physical abuse Following are signs of possible physical abuse (Child Welfare, 2021): ● The child has unexplained burns, bites, bruises, broken bones, or black eyes. ● The child has fading bruises or other marks noticeable after an absence from school. ● The child seems frightened of the parents and protests or cries when it is time to go home. ● The child shrinks at the approach of adults. ● The child reports injury by a parent or another adult caregiver. ● The child abuses animals or pets. ● The child has a fear of going home. ● The child has a fear of parent or caregiver. ● The child has extreme apprehensiveness/vigilance. ● The child has pronounced aggression or passivity. Sexual abuse Sexual abuse is defined as “a type of maltreatment that refers to the involvement of the child in sexual activity to provide sexual gratification or financial benefit to the perpetrator, including contacts for sexual purposes, molestation, statutory rape, prostitution, pornography,
exposure, incest, or other sexually exploitative activities” (USHHS, 2019). This definition includes situations in which a child engages in sexual activity for which they cannot give consent, is developmentally unprepared, is unable to comprehend, and violates the law or social taboos (Bechtel
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Book Code: FPA0625
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