Focus On Pediatrics-Teach the telltale signs of child abuse
Adults need to be more aware
Abuse affects a child mentally and physically, but often goes unreported to state child protective services because the signs are not recognized. In most states, professionals working with children are mandated by law to report suspicions of child abuse; there are many adults who could save a child if they were familiar with the signs of neglect, emotional, physical, or sexual abuse.
"Everyone who has contact with children should recognize the signs of abuse and know what to do, although not everyone is a mandated reporter," says Marjo DeForest, RN, MSN, staff nurse for the Center for Advocacy and Protection at Children’s Healthcare of Atlanta.
Patient education managers designing educational community outreach programs should check with the laws of their state to determine how abuse is defined and how it is investigated. However, there are red flags that signal an abusive situation every adult should know:
• Child neglect.
A child who is being neglected usually is filthy all the time and smells. "It’s not that they just have torn clothes or their clothes are too small, because that could be a lack of ability to provide and doesn’t mean that the intent is not to take care of them," says DeForest.
Another sign is hunger. The child may ask people they don’t know well if they have anything to eat or they may hoard food. A lack of dental care, a delay in seeking medical treatment for the child, or failure to meet the child’s needs, such as providing eyeglasses, could also signal neglect.
Leaving children home alone when they have not reached a level of maturity to care appropriately for themselves or leaving children in a dangerous situation also constitutes neglect.
• Emotional abuse.
Emotional abuse includes keeping a child in close confinement, torture, all forms of sexual abuse, verbal castigation, and failure to provide emotional nurturing and physical support. In infancy, one of the signals is failure to thrive. Because all abuse affects a child emotionally, the behavioral red flags that often signal sexual or physical abuse also are an indication that the child is emotionally abused.
• Physical abuse.
Signs of physical abuse might be visible such as bruises on parts of the body that aren’t likely to be caused by a fall or cigarette burns and bite marks. If physical abuse is involved in an injury, parents often refuse to seek medical intervention or they go the other extreme and rush the child to the emergency department with a story that doesn’t match the injury, says DeForest. For example, the child may have a broken leg and they tell the nurse that he or she fell off the bed.
Children who are being physically abused often dress inappropriately, wearing turtlenecks on a hot summer day to cover bruises. They also might exhibit behavioral symptoms such as lack of social skills, sleep disturbances, and poor peer relationships.
• Sexual abuse.
The physical signs of sexual abuse include frequent sore throats caused by oral sex, headaches, stomach aches, pain or itching in the genital area, difficulty walking or sitting, bed wetting, and bleeding or bruising in the genital, anal, or oral areas. "A child can have a normal physical exam and be sexually abused," says DeForest. Often there are no actual physical symptoms because the molester doesn’t do anything to hurt the child.
Behavioral signs include a sudden change in behavior such as a refusal to participate in school or social activities, inability to concentrate in school, secretive behavior, sleep disturbances, and a change in appetite. Sometimes a child will act up, hoping that he or she will be punished and no longer allowed to participate in a youth group or other activity where the abuse is taking place.
It is often difficult to pinpoint abuse because many of the behavioral symptoms could be caused by other events in a child’s life such as a death in the family or divorce. However, if the signs are there, it is better to report the abuse and let child protective services investigate, says DeForest. "Try to err on the side of the child. If you see three or four signs, that constitutes a red flag," she says.
For more information about teaching adults to recognize the signs of child abuse, contact:
• Marjo DeForest, RN, MSN, Staff Nurse, Center for Advocacy and Protection, Children’s Healthcare of Atlanta, 1001 Johnson Ferry Road N.E., Atlanta, GA 30342. Telephone: (404) 250-2674.
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