June 28th, 2012
By Jennifer Olin, BSN, RN
Child abuse and neglect stories often capture our attention in the news. The Jerry Sandusky Trial, the continuing trials of the Catholic Church, and all those local stories we each hear in our own hometowns.
While this is not a new phenomenon, the stressors of a poor economy and unemployment lend to the frequency of abuse. As nurses, it is one of our jobs, one of our responsibilities, to step in and report abuse and neglect when we suspect it.
Federal legislation lays the groundwork for identifying a minimum set of acts or behaviors that define child abuse and neglect. The Federal Child Abuse Prevention and Treatment Act (CAPTA), as amended by the Keeping Children and Families Safe Act of 2003, defines child abuse and neglect as, at minimum:
Within the minimum standards set by CAPTA, each state is responsible for providing its own definitions of child abuse and neglect. Most states recognize four major types of maltreatment: physical abuse, neglect, sexual abuse, and emotional abuse. Although any of the forms of child maltreatment may be found separately, they often occur in combination.
Major Types of Child Abuse and Neglect
Physical abuse is the non-accidental physical injury (ranging from minor bruises to severe fractures or death) as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object), burning, or otherwise harming a child, that is inflicted by a parent, caregiver, or other person who has responsibility for the child. Common indicators of physical abuse include:
These injuries are all considered abuse whether or not the caregiver intended to hurt the child. Physical discipline, such as spanking or paddling, is not considered abuse as long as it is reasonable and causes no bodily injury to the child.
Neglect is the failure of a parent, guardian, or other caregiver to provide for a child's basic needs. Neglect may be:
Common indicators of neglect include:
Sexual abuse is defined by CAPTA as "the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children."
Common indicators of sexual abuse and sexual exploitation include:
Emotional abuse (or psychological abuse) is a pattern of behavior that impairs a child's emotional development or sense of self-worth. This may include constant criticism, threats, or rejection, as well as withholding love, support, or guidance.
Emotional abuse is often difficult to prove and, therefore, child protective services may not be able to intervene without evidence of harm or mental injury to the child. Emotional abuse is almost always present when other forms are identified.
Abandonment and parental substance abuse are now defined in some states as other forms of abuse and neglect. Examples include:
The lists here are just some of the more common indicators of abuse and neglect. They are not exhaustive. Use common sense, and always err on the side of caution by filing a report when in doubt.
Child maltreatment is a significant public health problem in the United States. More than 700,000 children are confirmed as abused and neglected by Child Protective Services (CPS) each year. These confirmed cases, however, represent only a fraction, not the true magnitude, of the problem.
The definitions of child abuse and neglect may be a challenge to apply to a particular circumstance. Most importantly, it is our job as nurses to make sure the smallest suspicions are reported and not our job to determine whether these legal standards are met. If you suspect that a patient meets the criteria of theses circumstances you MUST file a report with your local authorities.