Neglect or abuse is most often inflicted by the child’s biological parents. Others who have been implicated include foster parents, babysitters, boyfriends, friends, and daycare workers.
Nurses are legally and morally responsible to identify children who may be maltreated and to report findings to protect the child from further abuse.
Neglect is the most common form of abuse and may include deprivation of basic physical or emotional needs: food, clothing, shelter, healthcare, education, affection, love, and nurturing. Emotional abuse stems from rejection, isolation, and/or terrorizing the child.
Physical abuse may result in burns, bruises, fractures, lacerations, or poisoning. Infants may suffer from “shaken baby syndrome” with severe or fatal neurologic injuries caused
by violent shaking of the infant.
Signs of shaken baby syndrome include retinal and subarachnoid hemorrhage. Signs of sexual abuse include bruising or bleeding of the anus or genitals, genital discharge, odor, severe itching or pain, and sexually transmitted diseases. A discrepancy between the nature of the child’s injuries and the reported cause of injury is a frequent clue that abuse has occurred.
Physical abuse. Physical child abuse occurs when a child is purposely physically injured or put at risk of harm by another person.
Sexual abuse. Sexual child abuse is any sexual activity with a child, such as fondling, oral-genital contact, intercourse, exploitation or exposure to child pornography.
Emotional abuse. Emotional child abuse means injuring a child’s self-esteem or emotional well-being. It includes verbal and emotional assault — such as continually belittling or berating a child — as well as isolating, ignoring or rejecting a child.
Medical abuse. Medical child abuse occurs when someone gives false information about illness in a child that requires medical attention, putting the child at risk of injury and unnecessary medical care.
Neglect. Child neglect is failure to provide adequate food, shelter, affection, supervision, education, or dental or medical care.
In many cases, child abuse is done by someone the child knows and trusts — often a parent or other relative. If you suspect child abuse, report the abuse to the proper authorities.
A child who’s being abused may feel guilty, ashamed or confused. He or she may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. That’s why it’s vital to watch for red flags, such as:
- Withdrawal from friends or usual activities
- Changes in behavior — such as aggression, anger, hostility or hyperactivity — or changes in school performance
- Depression, anxiety or unusual fears, or a sudden loss of self-confidence
- An apparent lack of supervision
- Frequent absences from school
- Reluctance to leave school activities, as if he or she doesn’t want to go home
- Attempts at running away
- Rebellious or defiant behavior
- Self-harm or attempts at suicide
Specific signs and symptoms depend on the type of abuse and can vary. Keep in mind that warning signs are just that — warning signs. The presence of warning signs doesn’t necessarily mean that a child is being abused.
Physical abuse signs and symptoms
Unexplained injuries, such as bruises, fractures or burns
Injuries that don’t match the given explanation
Sexual abuse signs and symptoms
- Sexual behavior or knowledge that’s inappropriate for the child’s age
- Pregnancy or a sexually transmitted infection
- Blood in the child’s underwear
- Statements that he or she was sexually abused
- Inappropriate sexual contact with other children
- Emotional abuse signs and symptoms
- Delayed or inappropriate emotional development
- Loss of self-confidence or self-esteem
- Social withdrawal or a loss of interest or enthusiasm
- Avoidance of certain situations, such as refusing to go to school or ride the bus
- Desperately seeks affection
- A decrease in school performance or loss of interest in school
- Loss of previously acquired developmental skills
Neglect signs and symptoms
- Poor growth or weight gain or being overweight
- Poor hygiene
- Lack of clothing or supplies to meet physical needs
- Taking food or money without permission
- Hiding food for later
- Poor record of school attendance
- Lack of appropriate attention for medical, dental or psychological problems or lack of necessary follow-up care
- Parental behavior
Sometimes a parent’s demeanor or behavior sends red flags about child abuse. Warning signs include a parent who:
- Shows little concern for the child
- Appears unable to recognize physical or emotional distress in the child
- Blames the child for the problems
- Consistently belittles or berates the child, and describes the child with negative terms, such as “worthless” or “evil”
- Expects the child to provide him or her with attention and care and seems jealous of other family members getting attention from the child
- Uses harsh physical discipline
- Demands an inappropriate level of physical or academic performance
- Severely limits the child’s contact with others
- Offers conflicting or unconvincing explanations for a child’s injuries or no explanation at all
Child health experts condemn the use of violence in any form, but some people still use corporal punishment, such as spanking, as a way to discipline their children. Any corporal punishment may leave emotional scars. Parental behaviors that cause pain, physical injury or emotional trauma — even when done in the name of discipline — could be child abuse.
When to see a doctor
If you’re concerned that your child or another child has been abused, seek help immediately. Depending on the situation, contact the child’s doctor or health care provider, a local child protective agency, the police department, or a 24-hour hotline such as Child help National Child Abuse Hotline (1-800-422-4453).
If the child needs immediate medical attention, call 911 or your local emergency number.
Keep in mind that health care professionals are legally required to report all suspected cases of child abuse to the appropriate county authorities or the police.
Request an Appointment at Mayo Clinic
Factors that may increase a person’s risk of becoming abusive include:
- A history of being abused or neglected as a child
- Physical or mental illness, such as depression or post-traumatic stress disorder (PTSD)
- Family crisis or stress, including domestic violence and other marital conflicts, or single parenting
- A child in the family who is developmentally or physically disabled
- Financial stress, unemployment or poverty
- Social or extended family isolation
- Poor understanding of child development and parenting skills
- Alcohol, drugs or other substance abuse
Some children overcome the physical and psychological effects of child abuse, particularly those with strong social support and resiliency skills who can adapt and cope with bad experiences. For many others, however, child abuse may result in physical, behavioral, emotional or mental health issues — even years later. Below are some examples.
- Physical issues
- Premature death
- Physical disabilities
- Learning disabilities
- Substance abuse
- Health problems, such as heart disease, immune disorders, chronic lung disease and cancer
- Behavioral issues
- Delinquent or violent behavior
- Abuse of others
- Suicide attempts or self-injury
- High-risk sexual behaviors or teen pregnancy
- Problems in school or not finishing high school
- Limited social and relationship skills
- Problems with work or staying employed
- Emotional issues
- Low self-esteem
- Difficulty establishing or maintaining relationships
- Challenges with intimacy and trust
- An unhealthy view of parenthood
- Inability to cope with stress and frustrations
- An acceptance that violence is a normal part of relationships
- Mental health disorders
- Eating disorders
- Personality disorders
- Behavior disorders
- Anxiety disorders
- Post-traumatic stress disorder (PTSD)
- Sleep disturbances
- Attachment disorders
You can take important steps to protect your child from exploitation and child abuse, as well as prevent child abuse in your neighborhood or community. The goal is to provide safe, stable, nurturing relationships for children. For example:
Offer your child love and attention. Nurture your child, listen and be involved in his or her life to develop trust and good communication. Encourage your child to tell you if there’s a problem. A supportive family environment and social networks can foster your child’s self-esteem and sense of self-worth.
Don’t respond in anger. If you feel overwhelmed or out of control, take a break. Don’t take out your anger on your child. Talk with your doctor or therapist about ways you can learn to cope with stress and better interact with your child.
Think supervision. Don’t leave a young child home alone. In public, keep a close eye on your child. Volunteer at school and for activities to get to know the adults who spend time with your child. When old enough to go out without supervision, encourage your child to stay away from strangers and to hang out with friends rather than be alone — and to tell you where he or she is at all times. Find out who’s supervising your child — for example, at a sleepover.
Know your child’s caregivers. Check references for babysitters and other caregivers. Make irregular, but frequent, unannounced visits to observe what’s happening. Don’t allow substitutes for your usual child care provider if you don’t know the substitute.
Emphasize when to say no. Make sure your child understands that he or she doesn’t have to do anything that seems scary or uncomfortable. Encourage your child to leave a threatening or frightening situation immediately and seek help from a trusted adult. If something happens, encourage your child to talk to you or another trusted adult about the episode. Assure your child that it’s OK to talk and that he or she won’t get in trouble.
Teach your child how to stay safe online. Put the computer in a common area of your home, not the child’s bedroom. Use the parental controls to restrict the types of websites your child can visit, and check your child’s privacy settings on social networking sites. Consider it a red flag if your child is secretive about online activities. Cover ground rules, such as not sharing personal information; not responding to inappropriate, hurtful or frightening messages; and not arranging to meet an online contact in person without your permission. Tell your child to let you know if an unknown person makes contact through a social networking site. Report online harassment or inappropriate senders to your service provider and local authorities, if necessary.
Reach out. Meet the families in your neighborhood, including parents and children. Consider joining a parent support group so that you have an appropriate place to vent your frustrations. Develop a network of supportive family and friends. If a friend or neighbor seems to be struggling, offer to babysit or help in another way.
If you worry that you might abuse your child
If you’re concerned that you might abuse your child, seek help immediately. These organizations can provide information and referrals:
The major nursing care planning goals for the child experiencing abuse includes ensuring adequate nutrition, safety of the abused child, relief from anxiety, improving parenting skills and building parental confidence.
Here are four (4) nursing care plans (NCP) and nursing diagnosis (NDx) for child abuse:
Imbalanced Nutrition: Less Than Body Requirements
- Imbalanced Nutrition: Less Than Body Requirements
May be related to
- Inability to ingest food
- Parental neglect on nutritional status
Possibly evidenced by
- Loss of subcutaneous fat
- Inadequate amount of food
- Weight loss
- Withholding of food by parent/caretaker
- Failure to thrive
- Child will manifest no further weight loss and, if malnourished, will gain 2.2 lb (1 kg)
|Assess for signs and symptoms of malnutrition.||A child with nutritional deficiency manifest decreased attention span, confused, pale and dry skin, subcutaneous tissue loss, dull and brittle hair, and red, swollen tongue and mucous membranes.|
|Monitor intake and output and food intake; Weigh client daily.||Allows the evaluation of the number of calories being consumed per day and progress of nutritional therapy.|
|Assess and record the amount, consistency, and color of stools and emesis.||Provide a guide on the absorption of nutrients in the body.|
|Maintain good oral hygiene prior meals.||Promotes good appetite and enhances the taste of foods/fluids.|
|Encourage parents to assist the child during feeding.||Eating as a self-care activity enhances self-esteem.|
|Encourage small, frequent feedings high in carbohydrates and protein.||Small meals decrease fatigue and are easier to tolerate.|
|Encourage adequate rest periods.||Minimizes fatigue and improve the child’s appetite.|
|Consider the possible need for enteral or parenteral nutritional support as indicated.||Nutritional support may be recommended for those who are unable to maintain nutritional intake by the oral route.|
|Consult and refer to a dietitian or nutritional support team for dietary counseling.||A dietitian or nutritional support team can
individualize the child’s diet within prescribed restrictions
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