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Seminar ON: Child Abuse
Seminar ON: Child Abuse
ON
CHILD ABUSE
Mr. Ashish Noel
M.Sc.Nursing ( Paed)
CHILD ABSUE
INTRODUCTION –
Child neglect is the most common form of
maltreatment. Neglect is generally defined as
the failure of a parent or other person legally
responsible for the child’s welfare to provide
for the child’s basic needs and an adequate
level of care.
(Nester, 1998 & Kaplan and Labruna, 1999)
TYPE OF NEGLECT –
History Taking
Physical Examination
Characteristics of child.
Environmental characteristics.
Parental Characteristic-
Violence,
Poverty,
Socially isolated,
SUGGESTIVE BEHAVIORS-
Dull and inactive; excessively passive or sleep,
Self - stimulatory behaviors, such ah finger - sucking or rocking,
Begging or stealing food,
Absenteeism from school,
Drug or alcohol addiction,
PHYSICAL ABUSE –
SUGGESTIVE PHYSICAL FINDINGS –
Bruises and Welts -On faces, lips, mouth, back, buttocks, thighs
regular patterns descriptive of object used such as belt buckle, hand,
wise hanger, chain, wooden spoon, squeeze or pinch mark.
Burns- on sole of feet, palms of hand, back or buttocks. Patterns
descriptive of object used, such as sound cigar or cigarette burns,
immersion in scalding water, rope burns on wrists.
Absence of ' splash' marks and presence of symmetric burns.
Stun gun injury: lesions circular, fairly uniform (up to 0.5 cm).
Fractures and dislocations-
Skull, nose or facial structures.
Multiple new or old fractures in various stages of healing.
Lacerations and abrasions-
On back of arms torso, face or external genitalia.
Descriptive marks such as from human bites or pulling hair out.
Chemical-
UN explained repeated poisoning, especially drug overdose.
CONT…. SUGGESTIVE BEHAVIOUR –
Wary of physical contact with
adults.
Apparent fear of parents or
going home.
Lying very still while surveying
environment.
In appropriate reaction to
injury, such as failure to cry
from pain.
Withdrawal behavior.
Superficial relationship.
Lack of reaction to frightening
events.
NURSING CARE OF PHYSICALLY
ABUSED CHILDREN
CHILD AND FAMILY ASSESSMENT –
Use age - appropriate methods to assess development;
preverbal and young children respond to play therapy with
folks that represent family members.
Provide age - appropriate support for the child during radio
logic and other diagnostic tests. - Document physical injuries.
Document observations of child behavior that indicate
psychologic and emotional status.
With other health care team members, complete the family
assessment.
PLANNING AND INITIATING CARE –
Assess level of knowledge and skill of parent
regarding childcare and development.
Identify one nurse as the child's primary care
giver.
Develop a clearly defined plan of case to be
followed by all nurses.
Involve older children in developing the plan for
their own care.
Plan patient care to include parental participation.
INTER DISCIPLINARY PARTICIPATION IN CARE –
Provide positive reinforcement for family / parent
strengths.
Model healthy communication and parenting behavior.
Inform parents that child protection services are being
notified. Without judging or accusing parents.
Explain that the objective of involvement is to
strengthen family functioning and prevent future harm
to children.
Support parents during initial interviews with child
protection workers.
Assist parents in identifying strategies necessary to
prevent future always.
PREVENTION FROM PHYSICAL ABUSE
The pediatrician's role in primary abuse prevention
includes identifying parents at high risk for being
unable to accept, love and properly discipline and
care for their offspring.
The history obtained from all parents should include
information about pregnancy planning, pregnancy,
emotional and physical health, domestic violence and
attitudes about the child and child- rearing
experiences.
Abuse and serious neglect may be prevented when
at- risk families receive intensive training and support
during pregnancy and after delivery.
PROGNOSIS –
Early studies of abused children
returned to their parents without any
intervention indicate that about 5 are
subsequently killed and that 2 5 are
seriously re- injured with
comprehensive, intensive family
treatment, 8- 9 of families involved in
child mal treatment may be
rehabilitated to provide adequate care
for their children.
EMOTIONAL ABUSE AND NEGLECT
SUGGESTIVE BEHAVIORS –
Self-stimulatory behavior such as biting, rocking.
During infancy, lack of social smile and stranger anxiety.
Withdrawal
Unusual fearful ness
Antisocial behavior, such as destructiveness, stealing, cruelty
Lags in emotional and intellectual development, especially
language
Suicide attempts.
SEXUAL ABUSE
Sexual abuse includes any activity with a
child, before the age of legal consent that is
for the sexual gratification of an adult or a
significantly older child. Sexual abuse
includes oral - genital, genital - genital,
genital - recta l, hand - genital, hand - recta l
or hand breast contact; exposure of sexual
anatomy, forced viewing of sexual anatomy;
and showing of pornography to a child or
using a child in the production of
pornography.
DEFINITIONS –
SEXUAL PLAY –
The other hand may be defined as viewing or
touching of the genitals, buttocks or chest by pre adolescent
children 4 separated by not more than 4 years, in which these has
been no force or coercion.
INCEST –
Any physical sexual activity between family members;
alone relationship is not required causes can include step parents,
upper siblings, grand parents, aunts and uncles does not include
sexual relations between legally sanctioned parents such as
spouses. E.g. Brother-sister.
MOLESTATION –
A vague term that includes “indecent
liberties”, such as touching, foundling, kissing, single or mutual
masturbations, or oral- genital contact.
CONT……..
EXHIBITIONISM –
Indecent exposure, usually exposure of the genitals by an adult
to children or other adults.
CHILD PORNOGRAPHY –
Arranging and photographing in any media sexual acts
involving children, either alone or with adults or animals, regardless
of consent by the child's legal guardian; also may denote distribution
of such material in any form with or with out profit.
CHILD PROSTITUTION –
Involving children in sex acts for profit and usually with
changing partners.
PEDOPHILIA –
Laterally means “Love of child” and does not denote a type of
sexual activity but the preference for pre pubertal children as the
means of achieving sexual excitement.
ETIOLOGY/ METHODS –
Gifts or privileges.
Misrepresents moral standards by telling the
child that it is 'okay’
Emotionally and socially impoverished children
Vulnerable children
CLINICAL MANIFESTATONS
SUGGESTIVE PHYSICAL FINDINGS –
Bruises bleeding, lacerations or irritation of external
genitalia, anus, mouth or throat
Torn, stained or bloody under clothing
Pain on urination or pain, swelling and itching of genital
area
Penile discharge
Sexually transmitted disease, non specific vaginitis or
venereal warts
Difficulty in walking or sitting
Pregnancy in young adolescent
Recurrent urinary tract infection
SUGGESTIVE BEHAVIORS
Sudden emergence of sexually related problems, including
excessive or public masturbation, age - in appropriate sexual play,
promiscuity or overtly seductive behavior.
With drawn, excessive day dreaming
Poor relationships with peers
Preoccupied with fantasies, especially in play
Regressive behavior, such as bed- wetting or thumb – sucking
Sudden onset of phobias or fears, particularly fears of the dark,
men, strangers or particular settings or situations (e.g. Undue fear
of leaving the house).
Running away from house - Substance abuse - Rapidly declining
school performance
Suicidal attempts or ideation.
INVESTIGATION –
Investigating the possibility of sexual abuse requires
supportive sensitive and detailed history taking.
History Taking
Physical Examination
Laboratory Findings- It depends on the history and the
time since injury.
Specimens of offender blood, hair and the victim's
mail clipping and clothing.
Gonorrhea and chlamydia cultures should be obtained
from the mouth, anus and genitals.
In the vagina, motile sperm can be found for 6 hr non
motile sperm exist for longer than 72 hrs.
TREATMENT –
It is a criminal offense and is investigated by the police
All victims of sexual abuse require psychological support.
The consequences and appropriate therapy of sexual abuse vary,
depending on the type of abuse; the age and other physical and
emotional factors in the victim.
The therapist may recommend that the victim of incest be returned
home he the perpetrator is out of the home.
Medication to prevent pregnancy may be given to post menarchal
girls with in the previous 72 hr intercourse.
Treatment with antibiotics is initiated to prevent sexually transmitted
diseases.
The offending parents and spouse should be referred for psychiatric
or psychologic evaluation.
NURSING CARE OF SEXUALLY
ABUSED CHILDREN
Nurse must be aware of the presenting symptoms that
frequently mask sexual abuse (abdominal pain, somatic
complaints with no identifiable cause).
Nurse must be able to support a patient / after
disclosure.
The nurse who understands the investigative
assessment procedure will be able to judge.
Nurse suggestions about age – appropriate ways to
gather data can be valuable to the interviewer.
The nurse provides support to the patient and family
and to record accurately child behavior and child –
parent interactions.
PREVENTION –
The primary prevention of sexual abuse is related, in
part, to normal developmental education and sexual
behavior.
Teaching children the proper names of all body parts,
including the names, function and significance of '
private parts' nipples, genitals and rectum
Teach to children should be say 'NO'.
Victim therapy should decrease the potential for re-
abuse.
Routine family discussions of uncomfortable events.
Written permission should be obtained from any
caregiver to allow a police screening for offenses.
PROGNOSIS –
With early and adequate intervention,
victims may lead normal adult lives.
However, even with intervention, certain
adolescent victims may run away from
home and fall to adolescent prostitution,
violence, drug addiction and unprepared
parenthood. Others who remain at home
may manifest a variety of emotional
problems, including depression, suicidal
gestures, deterioration in school
performance and conversion reactions.
NURSING ROLES IN PREVENTION OF
CHILD ABUSE
The nursing role in prevention of child abuse and maltreatment is
addressed here by using 5 objectives as a framework –
Increase public awareness of the nature and extent of efforts to
prevent child abuse.
Increase knowledge of health professionals.
Coordinate and improve the availability, accessibility and quality of
health services to families.
a. Advocacy for expanded health and social services for children
and families.
b. Identification and treatment of families at high risk for child abuse
and maltreatment.
Develop data systems to monitor the incidence and prevalence of all
forms of child abuse.
Research.
NURSING DIAGNOSIS –
Fear / anxiety related to negative interpersonal
interaction, repeated maltreatment, powerlessness,
potential loss of parents.
Impaired parenting related to child, caregiver or
situational characteristics that precipitate abusive
behavior.
Risk for trauma related to characteristics of child,
caregiver and environment.
Deficient knowledge about the child’s realistic
developmental abilities how to access external support
resources related to past inexperience with parenting.
OTHER NSG DIAGNOSIS –
Pain related to inflicted injury.