Child Abuse Elisa A. Mancuso RNC, MS, FNS Professor of Nursing.
-
date post
21-Dec-2015 -
Category
Documents
-
view
223 -
download
2
Transcript of Child Abuse Elisa A. Mancuso RNC, MS, FNS Professor of Nursing.
Child AbuseChild AbuseChild AbuseChild Abuse
Elisa A. Mancuso RNC, MS, FNSElisa A. Mancuso RNC, MS, FNS
Professor of NursingProfessor of Nursing
History
• Greeks- sacrificed to god
• England– children worked as chimney sweeps.
• America– children worked as coal miners.
Mary Ellen Case 1874
• First documented abuse case• Beaten and abandoned by
mother– left hours in closet
Etta Whealer social worker brought case to ASPCA
• Led to Society for Prevention of Cruelty to Children (SPCC)
Dr. Kempe1962 “The Battered Child Syndrome”
• Identified specific symptoms of abuse– Many bruises & old fractures on x-rays
• Urged MD’s to report suspected child abuse
• Lead to professional and public awareness of child abuse and neglect in the US.
Dr. Fontana
1963 “The Maltreatment Syndrome” • Identified children deprived of
food, clothing, shelter and parental love.
• Children not attaining appropriate growth & developmental milestones.
• No underlying pathological factor.
The Child Abuse Prevention and
Treatment Act 1974Provided federal funding to help fight child abuse
2008 Statistics• 3.5 million alleged abused or neglected • 905,000 actual victims
– 64.1 % Neglect– 16 % Physical– 8.8 % Sexual– 6.6 % Emotional– 2.2 % Medically Neglect
• 1,710 died = 4 children/day!!
• One child every 10 seconds being abused!! • • www.ocfs.state.ny.us/main/cps
Who are the abusers?
• 48 % male 52 % female
• 84 % being abused by parent
• 41 % MOTHER• 19 % FATHER• 17 % Both PARENTS
Abused ChildChild <18 years of age.Whose responsible adult-• Inflicts non accidental physical
injury• Creates risk of physical injury• Creates risk of emotional health• Commits or allows a sexual offense
against child• Has potential for abuse
Substance Abuse
Maltreated or Neglected Child
Child <18 years old Whose responsible adult:• Fails to provide the minimum
degree of basic needs.• Example:
Inadequate food, shelter or Abandoned child.
Emotionally Neglected Child
Child <18 years old • Failure to meet the child’s needs for
affection, attention and nurturing.• Failure to Thrive (FTT)
< 10th % in height and weight with no organic cause.
• Verbal abuse- “You’re stupid”• Kids can be aggressive and • impulsive, or have feeding
disorders
Abusive Adult
• May have been abused or neglected as a child.
• A MAJOR RISK FACTOR
• Learn aggression is appropriate.
• Difficulty controlling impulses and forming attachments
Substances Abuser
• Primary concern is habit • Little or no concern for
children.• Drug use decreases inhibitions
and impulse control• Increase in illegal activity
– Stealing or Prostitution – Involve children in prostitution
and pornography.
Social Isolation
• Lack of emotional support.
• Low self esteem.
• Moves residence frequently.
• Distrust others
Life Crisis• Multiple stressors/inadequate
coping mechanisms.• Single parents
– ↑↑ Responsibility for sole parent.
• Teenage pregnancy • “Babies having babies”
– Parents immature and fewer resources.
Homelessness
Knowledge Deficit
• View child as miniature adults.• Absence of Child Nurturing Experience• Parent had no loving relationship
– Expects baby to provide love.
• Violence and corporal punishment is accepted as discipline.
• Parents view child as bad or evil.
Unrealistic Expectations
• Limited knowledge – Unrealistic expectations of
appropriate developmental milestones
• Preemies and disabled children are @ high risk for abuse – Secondary to high tech constant
care.
Signs of Physical Abuse
Bruises- • Various stages of healing.• Bilateral and generalized. • Unilateral are usually with accidents.• Clustered patterns reflect objects
used:– Belt, hand, spoon, wire
• Face, mouth, lips, torso, back, palms, buttocks, thighs, soles of feet
Lacerations
• Mouth, lips, gums- oral sex
• Laceration of frenulum could be from forcing bottle in mouth or penis.
• External genitalia, penis, vagina, anus
Burns• Cigarettes
– circular and evenly shaped.
• Hot water submersion – “Sock like or Glove like” burn
•No splash marks.
• Stun gun– circular and uniform 0.5cm.
Fractures• Multiple fractures in various
stages of healing. • Spiral fracture = Red Flag!
• Old rib fractures/skull fractures.
• Dislocation of shoulder/elbow.
Head Injuries
• Hair pulling-bald patches.
Shaken Baby Syndrome• Whiplash from shaking• Subdural hematoma• Meningeal tear• Retinal hemorrhage• Seizures • Death
Poisoning
• Intentional giving harmful substances: Crack, cocaine, MDMA or alcohol.• Unintentional – Free Access (Neglect)
Munchausen Syndrome by Proxy• Parent fabricates illness of child• Gains attention & viewed as concerned• Signs of illness only occur when parent
• in room.
Sexual Abuse
2008 • 80,000 episodes/year (under reported)• Incest Molestation Rape• Child Pornography Child Prostitution
• Higher incidence with females • High risk with father, family member or
male friend • Rare for a stranger
Physical Signs of Sexual Abuse
• Sore throats• Vaginal infections• Bruises on hard/soft palate• Incontinence• Pain itching genital area• Torn stained bloody underwear• Loss in rectal tone Non-intact hymen in females
Behavioral Signs of Sexual Abuse
• Reluctant to change in gym class• Self mutilation• Excessive masturbation in young child• Withdrawal• Promiscuous behavior.• Alcohol/drug use• Eating disorders• Suicide Attempts Regressive behaviors Severe mood swings
Nursing Interventions
Provide privacy• Separate from parents• Maintain safe environment
• Monitor Verbal & Non-Verbal Cues!• Identify child’s words for genitals• Provide opportunity to talk• Abuse is not their fault• Reinforce that telling someone was right thing to do
Report ProcedureReport Phone # • 1-800-635-1522 (State Central Register) • 1-800-342-3720 (CPS hotline)
Immediately notify charge nurse/supervisor or can report independently.
• First oral report • Submit written report DSS-2221A in 48 H. • (Nursing supervisor or MD does this with
local CPS.) Report is admissible in court
DSS-2221A Report
• RN is mandated reporter.
• Class A Misdemeanor Failure to report suspected child
abuse/maltreatment
• Make report clear, objective and accurate.
History of Injury
• Date, time and place• Sequence of events• Describe parent and child
interactions – Are they appropriate?– Who does child reach out to?
• Presence of witnesses.• Interview with child and parent
individually.– Congruent reports?
Physical Examination
• SANE (Sexual Assault Nurse Examiner)
• Anatomical location of injury
• Size, shape and color of distinguishing marks.
• Pain or bone tenderness and ROM.
• State of health and hygiene Appears malnourished/unkempt
Documentation• Pictures
– Date, time, pt name, med record #. – X-rays
• Clothes– Note if torn, body fluids or bloody– Do not remove from the child if
possible
• Lab reports• Chain of custody must be• maintained.
Actions taken• What was done?
– If child admitted to hospital and CPS notified and will be involved.
• Where was child placed? – Relative’s home or foster care.
• Who was notified? – Name of case worker and case
number to be placed on chart.
• CPS must complete investigation
• in 60 days.