Peds, part 3: Principles - Types and Signs of Abuse and Neglect

December 15, 2021 Updated: January 17, 2022 8 min read

Full Transcript

Hi, I'm Meris, and in this video, I'm going to be talking to you about different types of child abuse, and the reporting requirements, and the signs of that abuse. So I just want to give you a big trigger warning, a big heads up before we get into any sort of content that the entire content of this video focuses on child abuse. So if that is triggering content to you, I would suggest skipping this video in its entirety. This is going to be sad content regardless, but if this is going to be triggering to you, please do not watch it. I'm going to be following along using our pediatric nursing flashcards. These are available on our website If you already have a set, I would invite you to follow along with me. And if not, go check out to grab a set for yourself. All right, let's get started.
So first up, we're going to be talking about the different types of abuse, along with risk factors for abuse. So types of abuse we have, we're going to be talking about four different ones. We have physical abuse, which is the intentional use of physical force against a child. So for instance, this could be hitting, kicking, shaking, burning, anything that could cause physical harm to a child. We have emotional abuse where we have behaviors that could harm a child's self-worth or self-esteem or their emotional well-being, such as name-calling, shaming, or rejection. We have sexual abuse, which would be forcing a child to engage in sexual acts such as fondling or penetration. And lastly, we do have neglect. And neglect is a little bit different in that this is failure to meet a child's basic physical needs. So this could be not providing housing or food, education, and even access to medical care is a form of neglect. Now, when we talk about risk factors, I want you to understand that these risk factors are just based on the aggregation of data. This does not mean that somebody with these specific risk factors is going to abuse a child. It's just things that have been shown through data to be linked to something like abuse. So I just want to put that out there because some of these things could be upsetting to somebody if they say, "Well, I fall into that category." It does not mean that you are an abuser. These are just possible risk factors. So first up, children who are less than four years old or who have special needs, such as if they have illnesses or disabilities, these children are more at risk for abuse. If you think about the kinds of children that are the most demanding are going to be those less than four, right? An infant cries frequently. A child less than four means a lot of attention and can have a lot of high needs, along with a child who has an illness or disability. So that can put them at risk for abuse. A family history of mental health issues or substance abuse can put a child at risk for abuse as well. Inconsistent, transient, or non-biological caregivers are also risk factors, as well as parents with low income or education levels, teenage parents, single parents, and parents who have many other young children. So all of those are possible risk factors for abuse.
Now when we talk about abuse, we need to talk about the signs of abuse in our requirements as nurses to report abuse. Now we're going to talk about signs of specific type of abuse in a moment. These are just general signs of abuse to keep in mind. Big one year, bold red text. Incompatibility between the story and the injury. So if the story and the injury don't match, that is a big red flag for potential abuse, right? We need to investigate that further inconsistent story between the child and the caregiver. So if the caregiver says one thing, but the child says another, even if neither one of them is saying anything about abuse, the inconsistency in the stories is a big red flag that this could be from abuse. Injuries that are extremely unlikely, given a child's developmental age. So the example we give here is a two-month-old who quote, "Crawled off the bed and hit his head." Right? That's very unlikely. A two-month-old can't crawl, right? It's possible for a two-month-old to fall off a bed. But this language of crawling is unusual. A child with burn injuries, if it's like a four-month-old, and they say that the "child must have turned the bathwater on and fallen in," that's very unlikely. It doesn't make sense, given the child's developmental age. Injuries that could have been avoided with basic parental supervision. This is another red flag for abuse. Now what is our job as nurses when it comes to reporting abuse? So this is so important to understand. Nurses are required to report the suspicion of abuse. So you do not need to have proof of abuse to report it. You just need to have the suspicion. The burden of proof does not lie on the person who reports it. So just because you report it does not mean you have to prove it. But you are a mandated reporter, meaning it is mandatory, it is required that you report abuse suspected abuse of a child, right, of any form. This is very important. You just need to give the facts in the circumstances that lead you to have this suspicion. But you don't have to give any sort of proof, right? Now if there is proof that is supporting evidence as well, but you just have to have the suspicion of abuse.
Okay. Moving on, we're going to talk about different signs of abuse here. So signs of physical abuse. If we have multiple injuries that are in various stages of healing, maybe we have multiple fractures or a lot of bruises, and they're all in different phases of healing, that could be a sign of abuse. Bruises on the cheek, neck, genitals, buttocks, or back. Those are all possible signs of abuse because, remember, that kids get a lot of bruises when they're little, right, but most accidental bruises for over bony provinces like the knees or elbows or shins-- my daughter is covered in bruises on her shins, right, because she is a preschooler. She's running around doing all kinds of stuff. She's got bruises on her legs, but she does not have them in these soft tissue areas, right? That's a big red flag. Bruises in the shape of a causative object, such as a belt, burns in the clear shape of an object. So, for instance, on an iron, right, that gives that pattern of an iron, or a cigarette burn, or what we call immersion burns. So if you put a child in hot water intentionally to cause pain that leads to burning, we would see those immersion burns, which means that they have a clear line of demarcation, meaning here's the burn, right, it goes all the way up to here. It stops. Nothing is burned here. That's what an immersion burn looks like. And then big, big, important thing to remember is that spiral fractures-- spiral fractures do not typically happen to a child without a twisting motion. So this is going to be something like grabbing a child by the arm and twisting and pulling up that could cause a spiral fracture versus they're playing on the playground and they fall down and break their arm. It's going to be a different type of fracture. There are some exceptions to this rule. And, again, that would have to do with the injury matching the story, right? Now, signs of shaken-baby syndrome in particular, which is a type of physical abuse, but this is more specific type of abuse, would be poor feeding, irritability, lethargy. So they're very tired. They're hard to wake up, vomiting, seizures, periods of apnea, right, where they stop breathing, retinal hemorrhage. All of those are potential signs of shaken-baby syndrome that is very important to know so that you can catch that if you should ever see that.
Lastly, we're going to talk about signs of emotional and sexual abuse, and also signs of neglect. So signs of emotional abuse. We might have a child with extreme behavior, so either they're overly compliant or very demanding. Maybe they are very passive or very aggressive, right? We're on either extreme here. Or delayed physical or emotional development. If we have a child who is not having their emotional needs met, they may not be developing emotionally the way we would anticipate. Now, signs of sexual abuse. Difficulty walking or sitting is going to be a big red flag here for sexual abuse. If a child exhibits advanced understanding or behavior sexually for their age, if a young child tells you about specific sexual behavior or is seen demonstrating or attempting to demonstrate that behavior, especially with other children, that should be a big red flag as well. If a child has a sexually transmitted infection, of course, that's going to be pretty obvious, but frequent urinary tract infections as well can be a sign of sexual abuse, especially in children with a vulva. And then new onset nocturnal enuresis, which means wetting the bed at night, right? So new-onset bedwetting can possibly be a sign of sexual abuse when it comes to neglect, though, things are going to be a little bit different. Frequently absent from school. That is going to be a big red flag of neglect. Nobody's making sure that this child is going to school. They are being neglectful. A child who is begging for food, or stealing food or money, right. Again, they're trying to meet their own needs because they're not being met by their caregiver. Unclean clothes, excessive body odor, poor dental health. All of those could indicate neglect. And then a child who is dressing inappropriately for the weather, that could be due to neglect as well.
I hope that review was helpful for you. Stay tuned because I have some quiz questions to help you test your knowledge of key facts I gave you in this video. Okay. So first up, we have a child who states that their caregiver calls them names. They make fun of them and they shame them. How does the nurse characterize this type of behavior? What type of abuse or neglect might this child be experiencing? Next up, a nurse suspects that a child may be being abused by their caregivers, but they don't have proof of this. How should the nurse proceed? Thirdly, what type of fracture should be a red flag to the nurse as potentially being caused by physical abuse? What type of fracture did I tell you was a red flag for abuse? And lastly, when caring for a child, the nurse notes in their history that the child has had frequent urinary tract infections, and they seem to be having difficulty walking and sitting. What type of abuse might the nurse suspect in this case? Let me know how you did. I hope this review was helpful for you. Thanks so much, and happy studying.

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