Identifying and reporting child abuse is perhaps one of the most difficult things a nurse has to do. All states have statutes that identify mandatory reporters of child abuse, and healthcare professionals are among those individuals in all cases. As a result, it’s important to know the signs of possible abuse and how to report it. Child abuse consists of four primary categories: physical, emotional, sexual and neglect.
1. Physical abuse – Signs of physical abuse include:
- unexplained injury (e.g., burns, cuts, bruises, broken bones, black eyes);
- antisocial behavior
- problems in school
- fear of adults
- arrives at school or activities early or stays late, and does not want to go home.
2. Emotional abuse – Signs of emotional abuse include:
- depression, apathy and hostility
- extremes in behavior – passive, aggressive, demanding;
- delayed physical or emotional development;
- suicide attempts
- indicates lack of attachment to parent;
- parent constantly criticizes or belittles child;
- parent ignores child’s problems
- parent overtly rejects child
3. Sexual abuse – Children experiencing sexual abuse often have unusual interest in or knowledge of sexual acts. Other key signs of sexual abuse include:
- diffculty walking or sitting
- refusal to change clothes for gym class or participate in physical activities;
- nightmares or bed-wetting
- fear of a particular person
- becoming pregnant or contracting a sexually transmitted disease, especially if younger than 14;
- reporting incidents of sexual abuse
- parent is overly protective of child and limits contact with others
4. Neglect – Signs of neglect include
- inappropriate clothing for weather
- poor hygiene
- constant and extreme hunger
- lacks medical care and/or immunizations
- begging or stealing food or money
- admitting no adult is at home
Other signs of an abusive situation include the following.
A child will:
- show sudden changes in behavior or schoolwork
- have learning problems not related to physical or psychological conditions
- have neglected medical problems
- be constantly anxious or alert
A parent will:
- show little concern for child;
- ask caregivers to use harsh punishment if child misbehaves
- openly blame the child for problems at school or home
Both will rarely touch or look at each other and both will admit they do not like each other. The four types of abuse often occur in combination. For example, a child who is physically abused probably receives emotional abuse as well.
Reporting Suspected Abuse
Although state laws mandate who must report suspected child abuse or neglect, anyone can and should report it.
A national hotline, Childhelp, is available 24/7 and is started with professional counselors to order resources. The hotline number is 800-4ACHILD (422-4453).
Most state health or social services departments operate toll-free numbers for people to call with reports of abuse or neglect. Sixteen states, the District of Columbia, American Samoa, Guam and the Virgin Islands require mandatory reporters of child abuse give their names and contact information. Connecticut, Delaware and Washington state allow child-protection personnel to ask the name of the reporter. Wyoming does not require reporters to give their name as part of the written report, but they must give it if they submit photos or X-rays of the child.
Resources for this article can be accessed at www.advance web.com/nurses. Click on Education, then References
Abigail Scott is senior associate editor at ADVANCE