When do you report to CPS?

[Purple_Scrubs, BSN, RN]

Dealing with child abuse allegations and suspicions: it is one of the most difficult parts of my job and presents some of the hardest decisions to make. Since April is National Child Abuse Prevention month, I thought I would pick your brains on a few scenerios (even though April is still a few days off). Here are three hypothetical situations, which would you report?

A) 5th grade boy comes to school with a black eye and broken blood vessels in the orbit. States that he fell off his bike and when he tumbled over, his eye hit his knee, causing the injury. Denies fighting, denies that anyone hit or hurts him. Says he feels safe and home and there are no problems at home.

B) 2nd grade girl with semi-circular, superficial abrasion on her chest. Says she fell off her bike, and the bike fell over on her. Says wound is from the end of the bike handlebars hitting her, because the plastic cover on it fell off which is why it cut her. Wound is already partially healed, but from looking at it, her story could be true. It also looks like it could possibly be a burn from a car cigarette lighter. It is impossible to tell which is more plausible.

C) 3rd grade girl makes an outcry and says her guardian hit her with a shoe. The way she describes it, she was swatted repeatedly on the upper thigh. No visible marks but student insists it left welts and is distraught. You are unable by policy to disrobe the student, and her shorts will only pull up far enough to see about half way up her thigh. Student says she does not want to go home and "I can't take it anymore!" Student is a frequent flyer and a known "drama queen". In the past, you have had to use a wheelchair to collect this child who fell and "could not move" her leg. There was no swelling, bruising, or visible injury and the child is known to use complaints like this for attention, when no "real" injury ever exists. This is in a state where spanking is an acceptable form of discipline, but it is illegal to injure a child so as to leave a lasting mark on their body.

Assume in all 3 cases you have never had any prior concerns about abuse with the students, and have no knowledge of any issues at home or other concerns. Which would you report?

[LACA, BSN, LPN, RN]

Tough question---they all three have their suspicions....The first two do sound possible, but I'm not sure they warrant a call to CPS. Maybe keep an eye out for further signs? Monitor the children for a while and see if anything else comes to light that would be better evidence of abuse?

The third one is a toughie simply because if there is no mark and no proof, then you will have a hard time proving child abuse based on the statement of a known "drama queen"....

I'm interested to see everyone else's thoughts on this!

[Artistyc1]

I think that I might have #3 go into the bathroom, and put on a garment of some sort that would cover her, but leave the upper thighs exposed. I would then take a look at that part of her- there can't possibly be any restrictions upon a school nurse examining thighs. There may be a problem here that has been overlooked by CPS in the past- at least there has been on many a student in my building. Just because possible previous CPS calls for this child in the past may have been seen as "unfounded" does not necessarily mean that "nothing happened" in my experience.

[BunnyBunnyBSNRN, ASN, BSN]

I thought about this all evening and have come up with the following:

1) No CPS call needed at this time. Might call the parents just to make sure everyone is on the same page care-wise.

2) Would call the parents and ask if they are aware of the injury. If their story varies from the kiddo's story, I would call CPS. That's a lot of detail to be given by a 2nd grader.

3) This one is the hardest (designed to be so, I'm sure). Call the parent with the child nearby. Tell the parent/guadian the child is reporting upper leg pain and ask if she c/o this at home that morning. If you get a bad vibe from home, call CPS. Remember, you can never be wrong calling if you SUSPECT a problem. It's not your job to figure out if there is a problem, it's CPS' you are only there to report.

how'd I do?

[Purple_Scrubs, BSN, RN]

Good thoughts. I really don't think there are right or wrongs. The scenerios are a combination of some given in a training exercise and some loosely based on reality.

My own thoughts: A and B I would monitor, and if anything remotely suspect pops up, then report. Calling the parents and even asking the child on a separate occasion are good ideas, and if anyone's story wavers even a little, it is worth a report. C I would report simply because it is an outcry. CPS will have to sort it out to see if there is any merit. Also the statement "I can't take it anymore" concerns me, even if the injuries do not, and that is worth taking a very close look at.

Thanks for the replies, I think by hearing each other's rationales, we can all learn a lot that will help in dealing with these tricky situations.

[mustlovepoodles, RN]

I would just monitor the first two, assuming that they were'nt frequent fliers with a history of other mysterious injuries. The third one i think I'd consider calling CPS. Just because she's a drama queen doesn't mean she's not telling at least some bit of truth. I'd also have the school counselor or school social worker talk with her and she how that plays out. I would probably NOT call the parent because I wouldn't want to tip my hand. Chances are, if this kid has made allegations before, CPS may already know this family anyway. You don't want to give them any reason to flee.

[DistrictNurse19]

I agree with Sara610. i always try to reach a parent/guardian for their "take" or their story...and then make a decision based upon that...not always easy and never fun, for sure.

[SchoolNurseBSN]

#3. No further thought. CPS call immediately! The other 2, I would have under my radar!

[abreezies]

Have you talked with the counselor and principal about this. I work very closely with my counselor! She does the actually calling and reporting, I only answer questions with regard to my physical assessment if asked.

[kidsnurse1969]

I would document carefully in all cases. Documentation of previous injuries will help validate the allegations if future injuries occur.

Perhaps the student is case #3 has been a frequent flyer because she was seeking help or looking for support because of the situation at home. I would have to make the call because of her claims.