To start, in Wisconsin, all nurses are lawfully-bound Mandated Reporters and must report neglect and/or abuse (Wisconsin Department of Children and Families, 2019). The reporting mechanism can depend on where you work but a rule of thumb is, if you find signs of abuse, you personally report it. In my county, we dial 920-236-4615 and speak to an intake worker, answer all pertinent questions, and let them make recommendations and take over the case (Winnebago County, 2019).
In my opinion, infants are the most vulnerable age of child when it comes to child abuse, as they are completely dependent, cannot verbalize abuse, and spend most of their days sleeping, masking signs of some kinds of abuse. Neglect is abuse in which the child is not receiving adequate nutrition, shelter, supervision, etc.; neglect might be the most obvious form of abuse. Typically these children are dirty, not dressed for the weather, have diaper rash, and have not had appropriate medical attention: immunizations, checkups, etc. (Green, 2018). Neglected children might rank poorly on growth charts or even regress from previous assessments, parents might appear to lack interest in the child, act under the influence, or be just as unkept (Green, 2018).
Physical abuse can also be quite obvious, as evidenced by bruises, cuts, broke bones, scars, abrasions, burns, and bite marks (Archana & Don, 2019). The infant might appear fearful of the parent or any adults due to their poor visual acuity; the parents might have conflicting or inconsistent stories related to the injuries, refer to the infant as evil or in negative ways, report physically disciplining the infant (CDC, 2019). Shaken Baby Syndrome (SBS) is another form of physical abuse, in which the infant is shaken, causing the brain to slosh around in the head, causing brain damage and death. Signs of SBS are lethargy, which can be easy to ignore as infants sleep a majority of the day, colic, seizures, posturing, bulging fontanels, nystagmus, unequal pupils (Green, 2019).
Less common forms of abuse of infants are sexual, medical and emotional abuse. Sexual abuse would be evident by oral, vaginal, or anal trauma, or blood in the diaper; medical abuse evident if the parent appears happy with their sick infant and attention paid by health care workers, unnecessary testing, and unexplained lab results; emotional abuse is probably harder to assess for, infants might be withdrawn or fearful of adults, delayed, and the parent might simply act as though they reject the child (Green, 2019).
Several cultural practices from Eastern (Asian) medicine that can be mistaken for child abuse, two of those practices are Gua Sha and cupping, both of which I have actually used a therapy for back pain. Both practices will be evident by bruising in the area of activity, usually the back, with Gua Sha resulting in longitudinal bruising following the spine and ribcage from rubbing the back with a spoon-like tool; cupping results in many circular bruises on the upper and mid back from glass cups suctioning to the back (Killion, 2017). These practices are believed to draw out toxins, provide pain relief, reduce inflammation, and increase blood flow, resulting in healing (Killion, 2017). These practices are not child abuse, just Eastern treatments that are not well known or prescribed.
Archana, K., and Don, K.R. (2019) Physical signs of child abuse. Drug Invention Today, 11(1), 189-192.
Centers for Disease Control and Prevention. (2019). Violence prevention: preventing child abuse & neglect. Retrieved from https://www.cdc.gov/violenceprevention/childabuseandneglect/fastfact.html
Killion, C. M., (2017). Cultural healing practices that mimic child abuse. Annals of Forensic Research and Analysis, (4)2, 1-4.
Green, S.Z. (2018). Health assessment of the infant. Health Assessment Foundations for Effective Practice. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/bios
Winnebago County. (2019). Child abuse and neglect reporting. Retrieved from https://www.co.winnebago.wi.us/human-services/divisions/child-welfare/child-abuse-and-neglect-reporting
Wisconsin Department of Children and Families. (2019). Mandated child abuse and neglect reporters. Retrieved from https://dcf.wisconsin.gov/cps/mandatedreporters
COMMENT 2 (150 words)
Children are prone to abuse at any age, but I chose the infant group to discuss abuse. Infants are the most vulnerable and dependent age group who cannot verbalize anything happening to them. They are more prone to neglect, which could be evident by diaper rash, malnutrition, failure to thrive, ranking poor on the growth chart, not being dressed up according to weather, not keeping him up-to-date on immunization and medical checkups. Physical abuse can be evident by broken bones, cuts, and burns (CDC, 2019).
Another form of abuse is the shaken baby syndrome, which is primarily seen in infants and children younger than age two. It usually occurs when a parent or other caregiver shakes a baby out of anger or frustration, often because the baby will not stop crying. Severe shaking causes the baby’s head to move violently back and forth, resulting in serious and sometimes fatal brain injury. The symptoms and physical findings include altered level of consciousness, irritability, drowsiness, vomiting, seizures, dilated pupils not respond to light, closed head injury bleeding, chest and abdominal injuring, and fracture to the skull (AANS, 2019).
Some cultural practices could be confused as child abuse. According to Hansen (1998), cupping and coining are the cultural practices that could be misinterpreted as child abuse. Cupping is a type of alternative therapy from China. It involves placing cups on the skin to create suction to blood flow and healing. The cupping leaves marks on the skin, which could be interpreted as a sign of abuse.
A registered nurse in the State of California is categorized as a mandatory reporter of abuse. As a mandated reporter, a nurse must report abuse or neglect when she sees as a physical or psychological sign of abuse or neglect or if she is reported by the patient or family. She reports to hospital authorities that further report to social service or the protective services following guidelines. Then protective services will take over from there. Meanwhile, she has to make sure the patient is safe (Board of Registered Nursing, 2010).
American Association of Neurological Surgeons (AANS) (2019). Shaken Baby Syndrome. Retrieved from https://www.aans.org/en/Patients/Neurosurgical-Conditions-and- Treatments/Shaken-Baby-Syndrome
Board of Registered Nursing (2010) Abuse Reporting Requirements. Retrieved November 28, 2019, from https://www.rn.ca.gov/pdfs/regulations/npr-i-23.pdf.
Centers for Disease Control and Prevention (CDC) (2019). Violence prevention: preventing child abuse & neglect. Retrieved from https://www.cdc.gov/violenceprevention/childabuseandneglect/fastfact.html
Falkner, Angel (2018). Age-Appropriate Approach to Pediatric Health Care Assessment. In Grant Canyon University (Ed.), Health Assessment: Foundations for Effective Practice. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for- effective-practice/v1.1/#/chapter/2
Hansen, Karen Kirhofer (1998). Folk Remedies and Child Abuse: A Review with Emphasis on Caida de Mollera and Its Relationship to Shaken Baby Syndrome. Child Abuse & Neglect: The International Journal, 22(2) p117-27. Retrieved from https://www-sciencedirect- com.lopes.idm.oclc.org/science/article/pii/S014521349700135X
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