child protection issue

Pediatric Critical Care Columnist · Jul 17, 2007

I see there are no responses to date. That might be because this topic strikes fear in the hearts of most peds nurses... No one wants to be the one to identify a child in need of protection. A few years ago I attended a workshop on child protection issues and I know I have some notes around here somewhere. Rather than hunting for them for hours, I'll see what I can recall...

Physical abuse is often obvious: bruises in spots that are rarely bruised accidentally (cheeks, back, abdomen, pelvis) or bruises that are shaped like household items (hairbrush, wooden spoon, egg turner, whisk, extension cord etc); burns with demarcated areas or patterns; spiral fractures. Neglect is a little harder to detect but still has red flags: dirty, ingrown toenails and poorly fitting shoes; untreated impetigo with or without scarring; dental caries in several teeth; under- or over-weight; matted hair.

Emotional and sexual abuse are sometimes harder to detect still, emotional because we can't "see" into the child's spirit, and sexual because the areas of injury will be hidden. Emotional abuse will sometimes manifest in self-abuse: headbanging, biting hands or arms, abnormal attachment to both family members and strangers (opening them up to more exploitation), cutting. Sexual abuse has some physical signs, such as frequent bladder infections, yeast infections in prepubescent girls, rituals, vomiting without symptoms of GI distress. Some behavioural clues include avoidance of persons, places or situations that should not provoke that degree of anxiety, overtly sexual or provocative behaviours, sexual play with dolls, inappropriate language.

That might be enough for your purposes...

samxh · Jul 17, 2007

Hi there. Thanks for you post. It has been very useful. I would say i came up with the same sort of answer, categorising different type of abuse.

Any way its nice to have someone out there who makes an effort to answer my question. So thanks again.

sam.

Pediatric Critical Care Columnist · Jul 17, 2007

You're totally welcome. I wanted to give others a chance to jump in, but nobody took the opening. Glad we were on the same wave length.

rnsrgr8t · Jul 20, 2007

This is a great question... one as a pediatric nurse we need to always have in the back of our head. I have been a pediatric nurse for almost 10 years. In the hospital where I work, we have a protocol and a specific team to call whenever there is suspected abuse.

Here is the protocol (it is a little long):

Suspect abuse with the following types of fractures (especially if child is under 2 years):

femur, humerous, posterior rib, metaphyseal, scapula, sternum, spine, multiple fractures, skull in an non-ambulatory child

Any unexplained injury

Implausible history given

delay in seeking medical care

Known/previous history of unexplained/suspicious trauma

Other things that are read flags for me are any sexually aggressive behavior from a very young child who should not be familiar with what they are doing. A child who is aggressive/abusive. A family that is continually noncompliant with the plan of care and it is putting the child's well-being into question. A parent that is obviously impaired, especially if needs to be driving child (alcholol/drugs etc).

As far as sexual/emotional abuse where there is no obivious physical signs, you need to follow your gut. If you are getting a bad feeling, run the situation by a more experianced colleague or the patient's physician. If you ever have any doubt, you need to investigate.

Our social work department is also a great resource that I have used to bounce a concern off of as well.

Pediatric Critical Care Columnist · Jul 20, 2007

Excellent response! Thank you...

GatorRN21 · Sep 24, 2007

Burns can always be prevented. Any kids with burns are always consulted with social services at our hospital.