1. Abuse in the Family and Community
Chapter 33:
Abuse in the Family and Community

2. Example of suspicious bruises.
Child Maltreatment
Family stressors and how the family handles these stresses may lead to child maltreatment.
Poor parenting skills may lead to child abuse if the parent has unrealistic expectations of the child or dysfunctional coping skills.
Physical punishment can be classified as abusive if it leaves marks, causes injury, or threatens the child's physical or emotional well-being.
Example of suspicious bruises.

3. Child Maltreatment (cont.)
Bruises that occur accidentally to a child usually appear over bony areas such as the knees, elbows, shin, and forehead.
Those that have been inflicted in an abusive manner may be found in soft tissue such as the buttocks, genitalia, thighs, back of the knees, upper back and nose and eyes.

4. Child Maltreatment (cont.)
Physical injuries may have distinctive outlines that indicate the instrument of abuse. A. Cigarette burn on child’s foot. B. Imprint from a radiator cover. C. Rope burn from being tied to crib rail. D. Imprint from a looped electrical cord.

5. Child Maltreatment (cont.)
Burn patterns from objects used for inflicting burns in child abuse.

6. Question Tell whether the following statement is true or false.
Child abuse has come to mean any act of physical, emotional, or sexual abuse, including acts of negligence, committed by a person responsible for the care of the child.

7. Answer
False
Rationale: The act of abuse must be intentional. Child abuse has come to mean any intentional act of physical, emotional, or sexual abuse, including acts of negligence, committed by a person responsible for the care of the child.

8. Shaken Baby Syndrome
Shaken baby syndrome causes a whiplash-type injury in the neck.
In addition, the child may have edema to the brainstem, brain hemorrhages, loss of vision, cognitive impairment, or even death.
The child might have clinical manifestations of lethargy, irritability, poor feeding, vomiting, and seizures or have no easily noted symptoms.

10. Munchausen Syndrome
Munchausen syndrome by proxy occurs when one person, commonly the mother, either fabricates or induces illness in another (usually the child) to get attention.

11. Emotionally Abused
A child may be emotionally abused verbally or by emotional unavailability of the family caregiver,
poor nurturing,
threats involving leaving the child,
or role reversal, in which the child must take on the role of parenting or is blamed for the parent's problems.

12. Child Neglect
Child neglect is failure to provide adequate hygiene, health care, nutrition, love, nurturing, and supervision.
Sexual abuse can be incest, sexual contact, or sexual assault and occurs in all socioeconomic, racial, religious, and ethnic groups.
Substance abuse, job loss, and poverty are often contributing factors.

13. Question
A 4-year-old boy is brought to the clinic with a vague history of stomach aches and vomiting. While in the clinic the nurse overhears the mother telling the child that if he doesn’t behave she will just leave him in the clinic and not come back for him. The nurse knows this is what kind of abuse?
a. Physical
b. Emotional
c. Neglect
d. Verbal

14. Answer
b. Emotional
Rationale: Emotional abuse includes insufficient or poor nurturing, or threatening to leave the child or otherwise end the relationship.

15. Nursing Process for the Child Who is Abused
Nursing care goals for the child who has been abused focus on caring for any injuries the child has sustained as well as relieving anxiety and fear.
Nursing care that promotes parenting skills and coping benefits the child as well.

16. Question What is one of the major goals for the abused child?
a. Subduing the abusive caregiver
b. Removing the nonabusive caregiver from the family
c. Relieving the child's anxiety and fear
d. Reporting the child’s injuries

17. Answer c. Relieving the child's anxiety and fear
Rationale: Major goals for the abused child include
Caring for any injuries the child has sustained
Relieving anxiety and fear

18. Domestic Violence in the Family
In cases of domestic violence, the child may have witnessed, heard, or seen evidence of the violence.
The child may be injured or have symptoms such as inability to sleep, bed-wetting, temper tantrums, withdrawal, and feelings of guilt.
He or she may have academic problems, frequent absences, behavior issues, or isolate him or herself from others.
The older child may use drugs or alcohol, commit crimes, or attempt or commit suicide.
These children may become victims or perpetrators of domestic violence as adults.

19. Bullying
The child being bullied may be the victim of physical, verbal, psychological, or cyber abuse.
Often the victim is perceived as somehow being different from others and thus “weaker.”
Symptoms may be physical or less obvious such as anxiety, changes in mood, decreasing school performance, or avoidance of certain situations.
Support from trusted adults may help the child develop self-confidence and be more able to cope with the bullying situation.

20. Parental Substance Abuse
The parent with substance addiction is not dependable and cannot provide stability for the child.
The parent may waver between overindulgence and the opposite—unreasonable and unpredictable behavior toward the child.

21. Parental Substance Abuse (cont.)
Behaviors seen in children who have an addicted parent include avoidance of interaction with classmates, failing in school, unexcused absences or truancy, frequent minor physical complaints, stealing or committing acts of violence, aggressive behavior, and abuse of drugs or alcohol.
Sometimes children behave in a positive manner to prevent attention being drawn to the family.
These children may take on the responsibilities the adult would normally take on, may become overachievers in school, or they may attempt to deflect the behaviors of their siblings by trying to make everyone feel good.