Scenario 3 ( continued) These exceptions disappoint and anger her parents. They tell her that they expect “only the best,” and failure to be the best will result in punishment. What people outside the family do not know is that this punishment is often physical. Katie’s friends often notice that she has bruises on her arms and legs, which she explains away by telling them she is clumsy and often gets hurt during gymnastics practices. One day, Katie’s gymnastics coach notices a laceration on Katie’s lower back that is swollen, red, and oozing pus-like draining. She sends Katie to the school’s counselor, who evaluates Kathy and starts asking her a few questions. “How did you get hurt, Katie?” the counselor asks. “I’m just clumsy.” Katie then begins to cry and pleads with the counselor not to say anything to her parents. “They will be so angry!” The counselor suspects physical abuse and prepares to report her suspicions.
Prevent Child Abuse New York (n.d.) defines physical abuse as “the non-accidental physical injury of a child inflicted by a parent or caretaker that ranges from superficial bruises and welts to broken bones, burns, serious internal injuries, and in some cases, death.” It is important to differentiate deliberate physical injury from accidental injuries. This is not always easy. However, there are some indicators of deliberate physical injury (Joyful Heart Foundation, 2022): ● Injuries to the eyes or to both sides of the head or body: In general, accidental injuries occur only on one side of the body. ● Bruises and other injuries that are in various stages of healing: This may suggest that abuse is occurring over long periods. ● Bruising, welts, or burns: Injuries that have specific shapes such as those resembling a belt buckle, a hand imprint, or round burns indicative of a cigarette burn should trigger an alarm that abuse is occurring. Bruising around the wrists and ankles may indicate that the child has been physically restrained. ● Bruising and injuries over areas of the body not normally visible: For example, bruising over the buttocks, chest, or torso may indicate that the abuser is injuring the child over areas that are not readily seen by people other than parents and other close caregivers. ● Frequent visits to the emergency department
the injuries (if the child is old enough to communicate). ● Bed-wetting in children who are already toilet trained. ● Fractures in various stages of healing or a history of repeated fractures. ● Human bite marks. Many people, including some healthcare professionals, may first think of such behaviors as striking, kicking, or shaking a child when physical abuse is committed. However, physical abuse may also include other acts (KidsHealth, 2015): ● Holding a child under water. ● Burning a child or scalding a child with hot water. ● Throwing an object at a child. ● Using an object to beat a child. ● Using physical restraints to discipline a child. Healthcare consideration: Children who have been physically abused may be seen wearing clothing that covers bruised or damaged areas of the body. For example, children may be dressed in long-sleeved clothing even in hot weather to cover bruised arms. If the child is taken to the emergency department or family physician, the abuser is usually reluctant to leave the child alone with healthcare professionals for fear that the child may talk about the abuse (Joyful Heart Foundation, 2022). Healthcare providers must be alert to any signals that the child’s safety is compromised.
because of injuries: The caregiver’s explanations of the injuries are often inconsistent with the injuries or do not coincide with the child’s explanation of
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