Child Abuse: Types, Risk Factors, Signs, and Reporting Requirements

Warning

• Trigger Warning: Content focuses on child abuse. Avoid if this topic triggers you.

Types of Child Abuse

1. Physical Abuse: Intentional use of physical force.
   • Examples: Hitting, kicking, shaking, burning.
2. Emotional Abuse: Behaviors harming a child's self-worth or emotional well-being.
   • Examples: Name-calling, shaming, rejection.
3. Sexual Abuse: Forcing a child to engage in sexual acts.
   • Examples: Fondling, penetration.
4. Neglect: Failure to meet a child's basic physical needs.
   • Examples: Lack of housing, food, education, medical care.

Risk Factors for Abuse

• **Children: ** Less than four years old or with special needs (illnesses, disabilities).
• Family History: Mental health issues, substance abuse.
• Caregivers: Inconsistent, transient, non-biological.
• Economic Status: Low income, low education levels.
• Parents: Teenage, single, or with many other young children.

General Signs of Abuse

• Incompatibility between the story and the injury: Story and injury don't match.
• Inconsistent story: Differences between child and caregiver reports.
• Unlikely injuries considering developmental age: Examples: A two-month-old crawling.
• Avoidable injuries: Injuries that basic parental supervision could have prevented.

Reporting Requirements for Nurses

• Mandatory Reporting: Nurses must report suspected abuse.
  • Suspicion is enough: No need for proof, just suspicion.
  • Give facts: Provide the circumstances that led to suspicion.
• Types of Abuse to Report: All forms of suspected child abuse.

Signs of Specific Types of Abuse

Physical Abuse

• Multiple injuries: Different stages of healing (fractures, bruises).
• Bruises in specific areas: Cheek, neck, genitals, buttocks, back.
• Patterns of injury: Bruises/burns in the shape of objects (belt, iron, cigarette).
• Immersion burns: Clear line of demarcation.
• Spiral fractures: Caused by a twisting motion (e.g., arm twisting).

Shaken-Baby Syndrome

• Signs: Poor feeding, irritability, lethargy, vomiting, seizures, apnea, retinal hemorrhage.

Emotional Abuse

• Extreme behavior: Overly compliant or demanding, passive or aggressive.
• Delayed development: Physical or emotional.

Sexual Abuse

• Difficulty walking/sitting.
• Advanced sexual behavior/knowledge for age.
• **Sexually transmitted infections (
• Frequent urinary tract infections.
• Nocturnal enuresis: New-onset bedwetting.**

Neglect

• School Absence: Frequent absences.
• Hunger: Begging or stealing food/money.
• Hygiene: Unclean clothes, excessive body odor, poor dental health.
• Inappropriate clothing: Not suitable for the weather.

Quiz Questions

1. A child says their caregiver calls them names and shames them. What type of abuse?
2. A nurse suspects abuse but has no proof. What should they do?
3. Which type of fracture is a red flag for physical abuse?
4. A child has frequent urinary tract infections and difficulty walking/sitting. What type of abuse is suspected?