Child abuse is a global problem, which unfortunately happens in every society, culture and communities. The term “Child Abuse” refers to intended acts that result in physical or emotional harm to children. Child abuse covers a wide range of behavior from physical assault by parents or other adult caretakers to neglect of child’s basic need. Child abuse is a social problem that affects millions of children each year, children less than 3 years of age being the most frequent victims. (Edelman & Mandle, 2010) For this article, the author chose to discuss child abuse and maltreatment in preschool age children. There are many forms of child abuse such as sexual abuse, physical abuse, verbal abuse, emotional abuse, neglect and abandonment/ separation. In this age most common abuses are physical, sexual, emotional and negligence.
As a health care provider when we are assessing a case of child abuse, we always need to check the background of the child’s family child, by checking parenting skills of caretakers, employment and education status of the parents, financial conditions at home and environment of the house (safe and clean for the child). We also need to check for any history of drug and alcohol abuse among family members, care taker’s personal limitations and certain cognitive or medical conditions (such as mental retardation or depression) of care takers, all these can effect child’s care tremendously. (Jarvis, 2011) Signs and symptoms nurses need to check for when they are assessing a preschool child for abuse are as follows: Physical Child abuse: Child has unexplained recurrent injuries, burns, fractures, bruises and bald patches. Child shows sign of fear and hesitation during physical exam (he is trying to pull himself away from examiner).
Child has difficult time concentrating and shows self-destruction tendencies & aggression towards others. Child is wary of adults and injuries on the body are inconsistent with the child’s age and developmental phase. (Center of Child Protection and Family Support, 2012) Sexual Child Abuse: Child has unusual or excessive itching in the private areas. Genital or anal area is torn, stained or underwear has blood spots. Child’s genital or anal areas could be injured, due to bruising, swelling or infection. Child plays inappropriately with his toys and makes inappropriate drawing according to his age. Suddenly child starts thumb sucking or brings out discarded cuddly toys to play. Child also exhibits a sudden loss of appetite or on the other hand eats compulsively, he starts being isolated or withdrawn from family/friends and becomes worried when clothing are being removed. Child frequently wets him/herself and often has nightmares. (Center of Child Protection and Family Support, 2012) Emotional Child Abuse: Parents or caretakers frequently yell, threaten or bully the child.
They are ignoring the child as a form of punishment, giving him the silent treatment for his needs and also show no signs of affection and love (i.e. hugs kisses and tapping the back). Child shows severe sign of depression, extreme withdrawal or aggression towards other people. Child could be overly compliant with his caretaker orders, too well-mannered and too neat or clean. Child also displays extreme inhibition while playing. Child could have extreme attention seeking behavior or failure to thrive behavior. (Center of Child Protection and Family Support, 2012) Child Neglect: Child has poor personal hygiene, unkempt clothes and hair. Child stays constantly hungry and seems very thin compared to the peer age group. Child has many unattended physical problems or medical needs, eg dental work and glasses. Child is frequently absent from school and forgets his lunch. Child has no social relationship with other kids and shows destructive tendencies. (Center of Child Protection and Family Support, 2012) If children been abused by parents and care givers during infancy, toddler and preschool age.
They show sign of developmental delay in displaying language, motor and social skills. Abused preschoolers respond to peers and other adults with more aggression and anger than do non-abused children. It is important for the nurse to understand certain cultural health practices that may be misidentified as child abuse. For example In Southeast Asian countries like Laos and Vietnam, people from Mien cultural beliefs in natural healing and use homemade remedies to treat most of the child disease. When a child suffers from restlessness, unremitting crying, agitation, constipation and loss of appetite, parents of the child use string of inner pulp (found in a special reed).The pulp is then dipped lightly in pork fat and lit. The flame is passed quickly over the skin above the pain site, which raises blisters on the skin or sometimes burn the skin which can easily misidentified as child abuse. To cover the blister and burn areas, they use Tiger Balm afterward.
Only older person in the family can do this ritual to cure child pain. (McIntyre & Silva, 1992) To report the child abuse in California State, nurse needs contact the California Department of Social services (toll-free number is 1- 800-422-4453) or call Sacramento county Child Protective Services – child abuse hotline at 916-568-6635. Any person who has knowledge of or observes a child whom he or she knows or reasonably suspects has been a victim of child abuse or neglect may report the known or suspected instance of child abuse or neglect. (California Department of social services, 2012) Description of report mechanism: Mandated reports of child abuse or neglect must include:
• The name, business address, and telephone number of the mandated reporter; • The capacity that makes the person a mandated reporter; and • The information that gave rise to the reasonable suspicion of child abuse or neglect and the source or sources of that information. If a report is made, the following information, if known, also must be included in the report: • The child’s name, child’s address, present location and if applicable child’s school, grade, and class. • The names, addresses, and telephone numbers of the child’s parents or guardians. • The name, address, telephone number, and other relevant personal information about the person or persons who might have abused or neglected the child. (California’s Child Abuse and Neglect Reporting Act, 2006)
California’s Child Abuse and Neglect Reporting Act: Reporting Rules for Health Care Providers, (2006). Retrieved from November 27, 2012 from: http://www.teenhealthlaw.org/fileadmin/teenhealth/teenhealthrights/ca/06_CA_ChildAbuseChapter.pdf California Department of social services. (2012). Child Abuse Prevention Services. Retrieved November 27, 2012 from: http://www.childsworld.ca.gov/PG1319.htm Center For Child Protection and Support,( 2012). Retrieved November 26, 2012 from: http://www.centerchildprotection.org/report_abuse.htm Edelman, C., Mandle, C. (2010). Health Promotion Throughout the Life Span. (7th ed.). Retrieved November 26, 2012 from http://pageburstls.elsevier.com/books/9780323056625/S6/0 Jarvis, C. (2011). Physical Examination and Health Assessment (6). Retrieved November 26, 2012 from http://pageburstls.elsevier.com/books/978-1-4377-0151-7/id/B9781437701517000078_c00007 McIntyre, T., Silva, P. (1992). Beyond Behavior. Culturally Diverse Childrearing Practices: Abusive or Just Different? Volume 4,