Categories of Child Abuse
- Physical ~ actual physical harm inflicted on a child.
- Sexual ~ a child is coerced into any form of sexual activity with little or no understanding of the actual implications of that activity.
- Negligence ~ the healthy development of the child physically, socially and emotionally are not achieved by the significant carer, ( e.g. failure to thrive)
- Emotional ~ when the child is constantly belittled by negative comments and response ( e.g. you're useless).
~ Child abuse can occur singly or any combination of the above
NB ~ Domestic violence puts children at risk, it can be a significant factor relevant to suspected child abuse.
Recognition of Non Accidental Injury (NAI)
The actual injury should equate to the mechanism/history of the injury as well as the development ability of the child.
- Fractures ~ types to be suspicious of: Humeral and Femoral fractures in children under the age of 2 should arouse suspicion of possible NAI. Also weigh this up to the history given by care givers
- Bruising ~ look at the type of bruising, the age of the bruise, the pattern of the bruising, e.g. fingertip bruises. Abnormal bruising over areas of the body not normally injured during child activities, e.g. abdomen, chest, back and perineum, the ears and bilateral black eyes, bruises on the upper limbs or the upper thighs which suggest that the child has been forcibly held. Various stages of bruising may mean repeated assaults over a period of time.
- Torn Frenulum ~ the tissue attaching the inside of the top lip to the inner upper jaw is not a common site of accidental injury, look for petechiae. (See info box for definition)
- Frozen Watchfulness ~ the child's eyes have a frozen look but follow your every move.
- Burns ~ scalds with inconsistent history (hx), burn marks, e.g. cigarette burns, poker, new and old burns.
- Bites ~ size, pattern and age
- The unconscious child ~ be aware in babies and small children of shaken brain syndrome. * Remember inconsistent history and mechanism of injury.
Points to remember ~
- The implications of domestic violence
- The family dynamics
- Abuse/NAI is classless
- The importance of history taking and mechanism of injury and its relevance in any indication of suspected abuse.
- Observation of how the injured child reacts and acts towards the significant adult carers and siblings, either younger or older
- The perpetrator of the abuse is usually known to the child/family, or friend of the family.
Therefore your priorities are:
- A+c B C and first aid treatment of any injury
- To ensure the child is physically safe and the child is conveyed to a place of safety (Hospital) and not put at any further risk, hence, history taking should be factual, any suggestion of suspicion of abuse may result in refusal to allow the child to go to hospital.
NAI is an emotive issue, your priority is to act in the best interests of the child at all times to ensure that the child is kept physically and emotionally safe.
Information reproduced from study notes kindly donated by Tracie Kendrew, Paediatric Emergency Nurse Practitioner
More Reading: Child Abuse and Neglect