Child abuse and neglect are severe issues, affecting the most vulnerable section of the population and often causing permanent trauma. As such, it is critical for a hospital worker to understand how to deal with the victims of such conduct. That means awareness of the definition, prevention, intervention, treatment and reporting of child abuse and neglect. The purpose of this orientation is to define all of the above and provide additional resources for self-study.
Definition of Child Abuse
The federal government defines child abuse and neglect as “at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm” (US Congress, p. 6).
The state of Florida defines abuse as “any willful act or threatened act that results in any physical, mental, or sexual abuse, injury, or harm that causes or is likely to cause a child’s physical, mental, or emotional health to be significantly impaired. Abuse of a child includes acts or omissions”. Neglect is defined as “when a child is deprived of, or is allowed to be deprived of, necessary food, clothing, shelter, or medical treatment; or a child is permitted to live in an environment when such deprivation or environment causes the child’s physical, mental, or emotional health to be significantly impaired or to be in danger of being significantly impaired. Neglect of a child includes acts or omissions”.
Prevention of Child Abuse
There are three levels of child abuse prevention activities: primary, secondary and tertiary. Each successive level focuses on a narrower section of the population with a higher risk of abuse occurring. Nurses are involved in all three levels to some extent and therefore have to be aware of what they represent.
Primary prevention is directed at the general population, raising awareness of child abuse. While it is mostly performed in the form of public service announcements, there are also state-funded parent education and family strengthening programs. Nurses work in such programs in the role of assistants and sometimes educators, informing parents about the potential risks and ways to avoid them.
Secondary prevention programs are offered to populations with a higher chance of child abuse occurring. Such risk is usually associated with poverty, substance abuse, young age, mental issues in parents, and disabilities in parents as well as children. Additional informational programs are available to them, but home visits, respite care, and family resource centers have all proven themselves impactful, as shown, for example, by Goldberg, Bumgarner, and Jacobs (2016). Naturally, nurses take the central role in all of these, as their skills in providing and teaching care are vital to the idea.
Finally, tertiary prevention programs are aimed at families where maltreatment has already occurred and have the goal of reducing the negative consequences as well as avoiding recurrence. At this level, nurses are mostly relegated to assistance, as the harm already done requires trained professionals to address it. They provide services such as family preservation counseling, mental health treatments, and parent support and mentor programs.
Detection of Child Abuse
The Child Welfare Information Gateway (2013) provides a significant list of signs that indicate a child might be suffering from abuse. The symptoms can be divided into three different categories: emotional, behavioral and physical. A nurse has to be watchful for all three groups when supervising children.
Emotional signs include extremes in behavior, reluctance to be near a specific person, sudden changes in appetite, quick attachment to strangers and acting strangely adult or childish. Behavioral signs include attempting to delay or avoid going home, begging for or stealing money, abusing animals or pets and frequent absences from school. Lastly, physical symptoms include unexplained injuries, particularly after absences from school, acting scared of the parents or adults in general, difficulty with walking or sitting, and sudden refusals to participate in physical activities.
Intervention, Treatment, and Reporting
In the state of Florida, anyone who knows or has cause to suspect that a child is being abused must report it. They do not have to identify themselves unless they are a professionally mandated reporter, such as a teacher, health care worker or law enforcement officer. The information can be reported to statewide hotlines, child protective services or law enforcement agencies. Treatment resources available in Florida include the Florida Abuse Hotline, Florida Coalition Against Domestic Violence, and the Ounce of Prevention Fund of Florida.
Differences between Abuse and Neglect
Child abuse and neglect are commonly grouped and viewed as one entity. However, the two are somewhat different when considered from a nurse’s standpoint. The difference lies primarily in the harm caused to the child, the treatment, and the signs and symptoms displayed.
The reporting requirements for child abuse and neglect are the same, being grouped under maltreatment. However, the specific types of the two differ somewhat, with abuse having a sexual subtype and neglect having medical and educational aspects. The treatments are similar because abuse and neglect cause unpredictable reactions in children, requiring a broad overarching treatment program to identify and resolve all possible issues.
Children who suffered sexual abuse have to be tested for sexually transmitted diseases and HIV as well as offered support and reassurance in case of pregnancy. In general, victims of physical and sexual abuse should undergo a thorough medical exam and receive psychological help regarding the injuries. Neglected children, however, need more attention paid to their mental issues, such as loss of self-esteem or dependent behavior.
Child abuse is a significant issue, and a nurse is expected to be able to handle every aspect of it. As such, they have to be aware of everything that pertains to the prevention, detection, and handling of such situations. Thoroughly learning all of this information is critical, as a nurse will likely have to utilize it at some point in their work.
US Congress (2011). S. 3817 — 111th Congress: CAPTA Reauthorization Act of 2010. Washington, DC.
Goldberg, J., Bumgarner, E., & Jacobs, F. (2016). Measuring program-and individual-level fidelity in a home visiting program for adolescent parents. Evaluation and program planning, 55(C), 163-173.
Child Welfare Information Gateway. (2013). What is child abuse and neglect? Recognizing the signs and symptoms. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.