Child Abuse and Maltreatment in Age Groups

Although childhood is made up of four distinct age groups, each one is distinctively different as well as the needs of the child involved (Falkner, 2018). In order to effectively care for children, you must be aware of the different stages of development and effectively utilize this knowledge while assessing and caring for the child. According to Falkner (2018) “the CDC defines child abuse as “any act or series of acts of commission or omission by a parent or other caregiver (e.g., clergy, coach, teacher) that results in harm, potential for harm, or threat of harm to a child” (CDC, 2017a, para 1).” According to the World Health Organization (2020) the “highest rates of fatal child abuse are found among children aged 0-4 years. The most common cause of death is head injury, followed by abdominal injuries and intentional suffocation.” Abuse commonly seen for the preschool (3-5) age group is abdominal trauma (Gonzalez, 2020) or physical abuse in general. In addition, abdominal trauma is noted to be the second most common cause of death from physical abuse according to Gonzalez (2020). Although sexual abuse can occur within this age group it is primarily prevalent in those who have already hit puberty, and predominately in girls versus boys according to the World Health Organization (2020).Some warning signs that abuse is present would be behavior changes.

Those who are abused in this age group often respond to peers and adults with aggression and anger. In addition, developmental delays are often seen in the presence of abuse. It is unclear to why these delays occur. The Encyclopedia of Childrens Health (2020) suggests these delays may be due to neurological damage or inadequate stimulation and uncertainty in their learning environment and the absence of positive interactions with their parents. Furthermore, these delays might cause further frustration with parents and ultimately cause even further abuse. Therefore, it is very important to recognize, and report abuse promptly.Within your nurses’ assessment some physical and emotional assessment findings you may see that indicate abuse are vast. Often with physical abuse, especially if ongoing, the child will present with bruising in various stages of healing. Bruising is often noted to the truncal region of the body that is primarily always covered with clothing to hide the evidence of abuse. This can also be noted to broken bones. Although there may not be various bones broken at the same time, there is often xray evidence of healed areas that can be noted. Emotionally, the inability to communicate could indicate emotional abuse that was caused by denial of communication or seclusion, unhealthy living conditions, or denial of the right to family life. Regression on behavior is also often identified in cases of emotional abuse. For example, children who are already potty-trained regressing back into urinating and having bowel movements in bed or in their clothing. Lastly, aggression is noted in those who have been abused regardless of the type of abuse.

There are various cultural practices used that could be misunderstood and misidentified as child abuse. According to Killion (2017) Coining is an ancient Vietnamese healing practice that mimics dermabrasion therapy where intense rubbing of the skin is utilized. This can cause redness, bruising, and blisters that may be seen as abuse. Cupping is another cultural practice carried out in the middle east, Asia, and Latin America. This practice is believed to remove harmful toxins from the body but often leaves round shaped bruising to the area, thus being misinterpreted as abuse. Although there are multiple examples not listed here that could be discussed I’m lastly going to discuss Moxibustion, which is often used within the Asian practice. Burning rolled pieces of Moxa Herb is applied to the skin directly often resulting in burns to the skin. I listed this because it came as a surprise to me that this is used in some cultures as I would have initially seen this as abuse.

I live in the State of Ohio, and according to Ohio Jobs and Family Services (2020) “the Ohio Department of Job and Family Services has launched 855-O-H-CHILD (855-642-4453), an automated telephone directory that will link callers directly to a child welfare or law enforcement office in their county.” Calls and reports can be given anonymously and should be reported even when in doubt. Nurses are considered as mandated reporters in the state of Ohio. When giving a report on the hotline there is a list of various questions to be answered. However, according to the Ohio Department of Job and Family Services (2020) if you do not have all of this information it is okay to proceed with the report, it is encouraged to always err on the safety of the child.

References

Encyclopedia of Children’s Health. (2020). Child Abuse. Retrieved 5/2/20 from 

Falkner, A. (2018). Health assessment: Foundations for effective practice. Chapter 2: Age-Appropriate Approach to Pediatric Health Care Assessment. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.2/#/chapter/2

Gonzalez D, Bethencourt Mirabal A, McCall JD. Child Abuse and Neglect. [Updated 2019 Nov 29]. In: StatPearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2020 Jan-. Available from: 

Killion, C. (2017). Cultural Healing that Mimics Child Abuse. Retrieved 5/3/20 from 

World Health Organization (WHO). (2020). Child Abuse and Neglect Facts. Retrieved 5/3/20 from https://www.who.int/violence_injury_prevention/violence/world_report/factsheets/en/childabusefacts.pdf

Re: Topic 2 DQ 1

is unfortunately more prevalent than many realize, especially during this COVID pandemic. The school-aged child 5-13 years is at the Erickson’s stage of development “Industry vs. Inferiority”. They are engaged in developing new skills and developing relationships with their peers.

The school-aged child is many times abused by a close family member or caregiver (Christian, 2015). Many times this person will groom the child over a long period of time relationally before the abuse begins. It is important for parents to be cognizant of adults that maybe doing this with their children.

The child may show signs of physical injury, which indicate physical abuse such as bruises (old/new), red marks, spiral fractures etc. Many times if sexual or emotional abuse is present this aged child will have poor academic performance, may develop ADHD, fearfulness, inappropriate sexual behavior, abnormal irrational fears and social with drawl.

Some cultures engage in certain behavior that in the United States maybe misidentified as child abuse. Some cultures use physical punishment (spanking). Some cultures introduce alcohol drinking socially at a much younger age then 21 yrs old. When I went on a mission trip to Russia, summer 2008, many young people drank alcohol. It was norm amongst their culture. As nurses when we assess the school aged child we must take into consideration the culture and their norms.

Texas where I reside and practice nursing has very strict laws and obligation by nurses to report child abuse. Below are the guidelines outlined on the Department of Family Protective Services website. Many emergency room nurses will be the first nursing staff to assess a patient with potential child abuse/neglect. However, a nurse in a pediatrician’s office may also come across a child of this age being abused. School nurses also play a role in their obligation to report.

Texas law requires that any person suspecting that a child has been abused or neglected must immediately make a report. If there is an emergency, call 911 and then call the DFPS Texas Abuse Hotline at 1-800-252-5400. You can also make a report onlineExternal Link

Professionals must make a report no later than the 48th hour after first suspecting a child has been abused or neglected or is a victim of an offense under Section 21.11, Penal Code. A professional may not delegate to or rely on another person to make the report (Texas Family Code, Section 261.101). Professionals are not required to follow up their oral reports with a written report as they were in the past. Professionals include teachers, nurses, doctors, day-care employees and others who are either licensed by the state or work in a facility licensed or operated by the state and who have direct contact with children in the course of their job (Texas Family Code, Section 261.101).

Maguire, S. A., Williams, B., Naughton, A. M., Cowley, L. E., Tempest, V., Mann, M. K., Teague, M., & Kemp, A. M. (2015). A systematic review of the emotional, behavioural and cognitive features exhibited by school-aged children experiencing neglect or emotional abuse. Child: Care, Health and Development, 5, 641. https://doi-org.lopes.idm.oclc.org/10.1111/cch.12227