1. Child Maltreatment and Unintentional Injury
Elizabeth Allen RN, MSN

2. Learning Objectives At the end of this presentation the learner will
Identify trends in age and type of child abuse and neglect based on latest available statistics
Differentiate between types of child abuse and neglect
Examine developmental considerations in potential for abuse, neglect and unintentional injury
Summarize anticipatory guidance for injury and abuse prevention in children of different age groups
Describe the team approach to care of the abused or neglected child, including mandated reporting
Define Munchausen by Proxy

3. Statistics
Most common abuser parent or guardian or male friend of the child’s mother
78% involves Neglect
Most abuse or neglect in newborn to 1 year age
70% of fatalities <3 years old
Girls slightly more abused or neglected than boys
Women more often perpetrators than med
80% of perpetrators were parents
Substance Abuse
Administration on Children, Youth and Families, Children’s Bureau, 2013)
(Childhelp, 2014)

4. Types of Abuse Acts of Commission versus Acts of Omission Commission
Physical Abuse
Failure to Provide
Sexual Abuse
Physical Neglect
Psychological Abuse
Emotional Neglect
Medical/Dental Neglect
Educational Neglect
Failure to Supervise
Inadequate Supervision
Exposure to Violent Environments
Commission: Words or overt actions that cause harm, potential harm, or threat of harm to a child. Acts of commission are deliberate and intentional; however, harm to a child may or may not be the intended consequence. Intentionality only applies to the caregivers' acts-not the consequences of those acts. For example, a caregiver may intend to hit a child as punishment (i.e., hitting the child is not accidental or unintentional) but not intend to cause the child to have a concussion.
Omission: The failure to provide for a child's basic physical, emotional, or educational needs or to protect a child from harm or potential harm. Like acts of commission, harm to a child may or may not be the intended consequence.
(CDC, 2014)

5. Developmental & Cultural Considerations
Age & developmental level influence abuse
What age group was most often affected in 2012?
Type of abuse influenced by developmental level
Shaken baby versus Fall or Burn
Cultural Practices may appear as abuse
Question thoroughly and with care to culture and language
Find out the family’s belief’s regarding the child’s illness, treatments
Safe Haven for Babies in AZ
Cupping

6. Prevention and Education
Unintentional Injury
May or may not be related to abuse or neglect
Does the story make sense: developmentally, individually? Is the story consistent?
Anticipatory Guidance and Safety
Accident Prevention- things to watch out for in each developmental group
Done at office visits, in ED or hospital
Based on Developmental Level
Many Resources

7. Child Maltreatment Mandated Reporter
Call hotline or local law enforcement
The following persons are required by law to report:
Any physician, physician's assistant, optometrist, dentist, osteopath, chiropractor, podiatrist, behavioral health professional, nurse, psychologist, counselor or social worker who develops the reasonable belief in the course of treating a patient.
Any peace officer, member of the clergy, priest or Christian Science practitioner.
The parent, stepparent or guardian of the minor.
School personnel or domestic violence victim advocates who develop the reasonable belief in the course of their employment.
Any other person who has responsibility for the care or treatment of the minor.
(Arizona Department of Economic Security, 2014)

8. Child Maltreatment Team Approach Care of the Child and Family
Physicians, Nurses, Social Workers, Psychiatrist & Psychologist
Police, Forensics, Lawyers
Care of the Child and Family
Innocent until proven guilty
Law Enforcement role
Photos, forensics
Tests and Interviews (ex. Skeletal Survey)
Department of Child Safety (AZ) or CPS custody
Supervision while in the hospital
Patient sitter
Nursing Care and Interventions
Nursing Diagnoses:
Pain, Acute
Health Maintenance, Impaired
Injury, Risk For
Violence: Other Directed, Risk For
Coping: Family, Disabled

9. Munchausen by Proxy The child is the Proxy
Form of child abuse- caregiver fabricates signs and symptoms of illness in their child
Motivation is for abuser to gain access to medical system to obtain attention as the caregiver (most often the child’s mother)
Suspected with:
unexplained, recurrent or extremely rare conditions
Illness unresponsive to treatment
Inconsistent history and/or physical findings
Symptoms occur in presence of the same caretaker and disappear when the child is separated from that caregiver