Physical Emotional Sexual Munchausen by Proxy Nursing Role CHILD ABUSE Physical Emotional Sexual Munchausen by Proxy Nursing Role

Child Maltreatment Intentional physical abuse or neglect, emotional abuse or neglect, and sexual abuse of children, usually by adults Neglect is the most prevalent form of maltreatment

Neglect Failure of parent or person legally responsible fro the child’s welfare to provide for the child’s basic needs and an adequate level of care (Wong et al, p. 697). Etiology unknown Influencing factors that can play a part in neglect Ignorance of child’s needs lack of resources can play Parental lack of knowledge on emotional nurturing as an essential need of the child

Neglect Physical Emotional neglect Emotional abuse Deprivation of necessities Food, clothing, medical attention, education, shelter Emotional neglect Failure to meet a child’s needs for affection, attention, and emotional nurturance Emotional abuse Deliberate attempt to destroy or significantly impair a child’s self-esteem or competence. Rejection, isolation, terrorizing, ignoring, or corrupting the child (Wong et al, p. 697)

Physical Abuse Deliberate infliction of physical injury on a child usually by the child’s caregiver “Non-accidental injury of a child ranging from minor bruises and lacerations to severe neurologic trauma and death” (council on scientific affairs).

Physical Abuse Munchausen by Proxy Illness that one person fabricates or induces in another person Mother is often perpetrator in children Warning signs Unexplained, prolonged, recurrent, or extremely rare illness Discrepancies b/t clinical findings and hx s/s occurring only in parent’s presence Parent knowledgeable about illness, procedures, tx Parent very attentive toward child Family members with similar symptoms

Physical Abuse MSP cont’d Common presentation of children with suspected MSP Apnea, seizures, bleeding, vomiting, diarrhea, and hematuria Illness is usually dramatic and results in repeated visits to several health care facilities Suspected MSP Contact child protection team to form treatment and intervention plan for the child and parent

Physical Abuse Predisposing factors Typically one child is victim in an abusive family Occurs in all family types Interaction b/t several factors increases the risk of abuse ># of factors= > risk of abuse Characteristics of child that can contribute to physical abuse Child’s temperament Position within the family Disabled Activity level Degree of sensitivity to parental needs

Physical abuse Predisposing factors of abuse Parental characteristics Parental hx of abuse or neglect during childhood Unable to or loss of controlling aggressive impulses Socially isolated with fewer supportive relationships Children of teenage moms Parental lack of knowledge in childrearing Parental low self-esteem

Physical Abuse Predisposing factors Environmental characteristics Poverty Chronic stress Divorce Unemployment Alcohol or drug addiction

Sexual Abuse “the use, persuasion, or coercion of any child to engage in sexually explicit conduct (or any simulation of such conduct) for producing any visual depiction of such conduct, or rape, molestation, prostitution or incest with children” (Child Abuse and Prevention Act Public Law 100-235) Child abuse must be committed by person responsible for the child’s care (parent, babysitter) If it is a stranger who is doing the abuse it is sexual assault

Sexual abuse Incest- any physical sexual activity b/t family members Includes stepparents, grandparents, uncles etc Molestation- “indecent liberties” (Wong et al, p. 699) touching, fondling, kissing, masturbation Exhibitionism-indecent exposure Child pornography-arranging and photographing sexual acts involving children Regardless of consent from parent Child prostitution-sexual acts for profit Pedophilia-means “love of child” preference for prepubertal children as a means of achieving sexual excitement

Sexual Abuse Characteristics of Abusers Characteristics of victims Can be anyone Typically male that the victim knows Presence of stepfather (incest) Characteristics of victims anyone runaways

Sexual Abuse Initiation and perpetuation of abuse Pressure to begin sexual activity Gifts Special secret Abusers play on fears Fear of telling Fear that they will be blamed Child is to young to tell what happened

Nursing Care Assessment Early detection and identification are key See box 16-13 p. 701 for clinical manifestations of maltreatment and abuse Necessity for nurses to recognize physical and behavioral signs Through physical exam and detailed history are the most important diagnostic tools to identify abuse Typically a combination of manifestations or indicators suggest abuse

Nursing Care assessment Note evidence of maltreatment Bruises, burns, fractures, abrasions, withdrawn behavior, sleep disturbances see p. 701 Shaken baby syndrome Can cause fatal intracranial trauma without signs of external head injury Suspect infants <1 yo. Present with subdural or retinal hemorrhages

Nursing Care assessment Evidence of maltreatment Sexual abuse Difficult to prove, few obvious physical indicators Watch for verbal and behavioral that suggest abuse UTI, swelling of the genitals, unusual odor, withdrawn behavior, poor relationships with peers, regressive behaviors, i.e. bedwetting

Nursing care assessment History of incident Watch for incompatibility b/t hx and injury Note relationship b/t parent and child Conduct and interview of what happened Provide neutral env’t Non-leading questions Move in chronological pattern Non-sexual to more sexual Be sensitive and avoid biasing questions Try play therapy with dolls or drawings

Nursing care assessment History of incident cont’d Parental behaviors Show little signs of concern Unable to comfort child Critical with child and angry for getting injured Concerned with own needs instead of child’s Child behaviors Unresponsive to parent Excessive clinging and intolerance of separation Fearful of physical contact

Nursing Diagnosis Risk for trauma Fear anxiety r/t negative interpersonal interaction, repeated maltreatment See p.708

Plan when suspected abuse Protect child from further abuse Notify DCFS Nurses are mandatory reporters Support child Support family Plan for discharge

Child Abuse Prevention Early interventions for new parents Teach children about “good touch and bad touch” Educate children on what to do if “bad touch” Teach parents about the reality of child abuse and the need to be aware of its possibility Parents need to listen to their children’s concerns Believe children Seek assistance from professionals to help the child and the family to have a healthy outcome