Healthcare providers, including nurses, have a responsibility to understand the signs of child abuse and what to do if they suspect that a child is a victim of abuse. While child abuse is a difficult topic to discuss, providers need to be aware of the signs. They must know how to intervene, starting with identifying child abuse.
Unfortunately, child abuse in the United States is not uncommon. An estimated one in four girls and one in fourteen boys experience child abuse. In the year 2022, authorities reported that 558,899 children experienced abuse.
Related: Child Abuse: Identification and Intervention
Types of abuse
Healthcare providers should have the skills needed for identifying child abuse in all its forms. Some, like physical abuse, are easier to identify. Other types of abuse, such as emotional abuse, can be difficult to identify and treat. One type of abuse is not necessarily more serious than another. Any type of mistreatment should be addressed by someone who has the knowledge and experience to respond appropriately.
Emotional abuse
Emotional abuse is the most difficult type of abuse to identify, but it can be just as harmful to a child as any other type of abuse. Emotional abuse is maltreatment that includes punishing, berating, or belittling a child for normal behavior. This purposefully harms a child’s self-esteem, discourages healthy relationships with others, or exposes the child to family violence.
Physical abuse
Physical abuse is usually the easiest to identify. Physical abuse involves intentionally causing harm to another person in an attempt to control or punish them. Children experiencing this type of abuse may show repeated injuries and have bruising in different stages of healing, unexplained cuts or scars, burns, scratches, or bite marks.
Shaken baby syndrome is a specific type of physical abuse that is often seen in infants and young babies. Parents and caregivers may shake the child violently back and forth in an attempt to get them to stop crying. This can result in concussions, traumatic brain injuries, and even death.
Neglect
Children who are neglected may seem withdrawn and have very little energy. These children are not receiving age-appropriate care in their homes. Children experiencing neglect are often malnourished, have poor hygiene, and do not have the correct clothing for the weather. Neglected babies may develop severe diaper rash and show signs of dehydration, such as dry skin and cracked lips.
Some children experience medical neglect, where their caregiver does not give them access to the medical care that they need.
Sexual abuse
Sexual abuse is defined as an interaction between a child and an adult or another child in which the child is used for the sexual stimulation of the perpetrator. This may include inappropriate touching or even encouraging a child to touch themselves while the perpetrator watches, takes pictures, or records a video. Most children who are the victims of sexual abuse know and trust their abuser.
Sexual abuse may cause pain, bruising, or bleeding in the genital area. Children who are experiencing sexual abuse may have more knowledge about sex than is normal for the child’s age. Children may try to protect their abuser or want to keep secrets about the abuse.
Identifying child abuse
Identifying child abuse is not always as easy as it sounds. The signs and symptoms of abuse can mimic the signs of other problems, such as behavioral problems and some medical problems.
In a few examples, a child with gastroenterological problems may be small for their age or have very little appetite. Many ADHD medications can cause weight loss in children. Mongolian spots, sometimes present on babies’ skin, can look like bruises.
While it can be a challenge to be certain, healthcare providers should be on the lookout for the following:
- Abrupt changes in behavior
- Withdrawal from normal social activities
- Bruising, especially multiple bruises
- Lethargy or weakness
- Clothing that is inappropriate for the weather or activity
- Extreme hunger or lack of food during mealtimes
- Acting out with violence
- Acting out sexually
- Sexual knowledge that is not appropriate for the child’s age
- Sunken eyes
- Dry lips or skin
- Frequent absences from school
- Anxiety
- Depression
Reporting laws
Abuse of a child can have devastating consequences. Children who are the victims of any type of abuse are at a high risk of suffering from low self-esteem, depression, poor relationships with others, and engaging in abusive behaviors themselves.
If you suspect that a child is the victim of any type of abuse, it is important to notify the correct people. It is not up to a healthcare provider to determine whether a suspicion of abuse is correct. However, healthcare providers do have an obligation to report their concerns.
Nurses are mandated reporters. This means that they must report any abuse to the proper authorities. If you suspect that a child is currently or has been the victim of abuse, contact your supervisor, who can help you file a report with a local child protection agency. If you feel that a child is in immediate danger, call the local authorities.
Nursing care of the abused child
Children who are the victims of abuse should be protected and treated with kindness and patience. These children may not want to cooperate for fear of retaliation or fear of getting their caregiver in trouble. They may have been told by their primary caregiver to keep the abuse a secret and may struggle to explain what is happening to them.
It is important to remain calm and nonjudgmental when speaking to these children. A big reaction may scare them and make them hesitant to explain further. The best thing you can do is get a trained social worker or child protective services involved as quickly as possible.
Why does this happen?
Adults abuse children for many reasons. Adults who abuse children may have poor coping skills or unrealistic expectations about how children should behave. Often, they have little understanding of how to parent or discipline a child, and some may be struggling with addiction or substance abuse.
Most parents and caregivers do not want to abuse children. They may be struggling with their own mental health challenges, lack the skills they need to care for a child, or be experiencing abuse themselves. While a child’s safety should always be the first priority, it is important to get help and resources from their caregivers as well.
