Identifying and Preventing Child Abuse

Whether a nurse in the emergency department or a school psychologist, healthcare professionals are often uniquely placed to spot the subtle signs of abuse in children.

In recognition of National Child Abuse Prevention Month, we’re shining a light on the most common types of child abuse in the U.S., as well as reviewing the signs, risk factors, and mandated reporting policies that impact healthcare professionals.

The many faces of child abuse

Tragically, child abuse comes in many forms. The most prevalent include neglect, physical, sexual, or emotional abuse, and FDIA, or Factitious Disorder Imposed on Another, also called Munchausen syndrome by proxy (MSbP).

While not always mutually exclusive, the U.S. Department of Health and Human Services defines each type of maltreatment by the following criteria:

• Neglect: The failure of a parent, guardian, or other caregivers to provide for the basic needs of the child, whether physical, emotional, educational, or medical. The following are considered forms of neglect in many states:
  • Abandonment: A child has been left alone in circumstances where they suffer serious harm when the parent’s identity or whereabouts is unknown, or the parent has failed to maintain contact with the child or provide reasonable support for a specified period.
  • Parental substance abuse: The child is prenatally exposed by the mother’s drug use, the child is present during the manufacture of methamphetamine, or the child’s caretaker uses a controlled substance in such a way as it impairs their ability to care for the child.
  • Human trafficking: The child is trafficked for sex and/or labor, which may include drug dealing, begging, or working for little pay.
• Physical abuse: The child receives an intentional physical injury (via biting, shaking, throwing, stabbing, punching, beating, kicking, choking, hitting, burning, or other means). To note, physical discipline (spanking or paddling) is not considered abuse as long as it does not cause bodily injury and is considered reasonable.
• Sexual abuse: Includes fondling a child’s genitals, sodomy, indecent exposure, penetration, incest, rape, and exploitation through prostitution or the production of pornographic materials.
• Emotional or psychological abuse: The child is the subject of a pattern of behaviors that impair their sense of self-worth or emotional development, and may include threats, constant criticism, rejection, and/or withholding support, love, or guidance.
• Factitious Disorder Imposed on Another (FDIA), or Munchausen Syndrome by Proxy: The child’s caregiver either harms the child or fabricates symptoms of an illness in order to receive medical attention.

Related: Child Abuse and Neglect: Identifying Child Abuse & Responding Appropriately

Grim statistics

According to the Centers for Disease Control and Prevention (CDC), child abuse is the fourth leading cause of death in children between one and four years of age.

In 2017, 50 states reported a combined total of 1,688 fatalities from abuse and neglect, which represented a national rate of 2.32 deaths per 100,000 children. Of the children who died, 75.4% suffered from neglect and 41.6% suffered from physical abuse.

Perpetrators were most likely the parents of the children, while only 4.7% of perpetrators were a relative other than a parent.

Signs of child abuse

Identifying symptoms of child abuse can prove difficult for healthcare professionals. There are often few witnesses to the abusive behavior besides the child and the perpetrator, and the child may be preverbal, too injured, or too frightened to disclose the abuse to a stranger.

Psychosocial cues of abuse from the child may include sudden changes in behavior or school performance, extreme vigilance, reluctance to be around the perpetrator, or vague/contradictory explanations for significant injuries.

Significant delays in seeking medical attention may also indicate abuse, as an abuser may not bring their child to a doctor unless they perceive the injury to be life-threatening.

A neglected child may exhibit unaddressed medical or dental needs, steal food or money, have frequent absences at school, lack weather-appropriate clothing, abuse alcohol or drugs, or demonstrate persistent poor hygiene.

Potential risk factors

While abuse can take place in any household, there are several factors that contribute to the likelihood of an abusive environment, including:

• Unemployment
• A high density of alcohol outlets in the vicinity
• Non-biologically related male living in the home
• A stressful environment
• A history of violence
• Social isolation
• Poverty

Risk factors for victims may involve emotional or behavioral difficulties, physical or developmental disabilities, unplanned pregnancies or preterm birth, or chronic illness. Perpetrators may exhibit patterns of low self-esteem, substance and alcohol abuse, antisocial personality disorder, depression and mental illness, domestic or intimate partner violence, or a history of abuse in their own childhoods.

Reporting procedures

Child abuse and neglect legal definitions and reporting requirements vary from state to state, but all 50 states have mandated reporting of suspected abuse or neglect by healthcare professionals to a CPS agency.

For those who may suspect child abuse or neglect, it’s critical to ensure the child’s immediate safety, including medical treatment. That may involve the police, relatives, or foster care, as well as CPS.

For more information on state-specific statutes and policies regarding child welfare, visit the U.S. Department of Health and Human Services’ resource portal.

This article is based on the 6-hour Child Abuse: Identification, Management, and Reporting course written by Margaret Nihoul, MSN, RN, CPRNP-PC and presented by Elite Learning.