216 Unit 3 CURRENTSOCIAL ANDEMOTIONALCONCERNS
thing—the parents are well educated with successful
careers, and the family is financially stable.
Parents who abuse their children often are emo-
tionally immature, needy, and incapable of meeting
their own needs much less those of a child. As in
spousal abuse, the abuser frequently views his or her
children as property belonging to the abusing parent.
The abuser does not value the children as people with
rights and feelings. In some instances, the parent
feels the need to have children to replace his or her
own faulty and disappointing childhood; the parent
wants to feel the love between child and parent that
he or she missed as a child. The reality of the tremen-
dous emotional, physical, and financial demands that
comes with raising children usually shatters these un-
realistic expectations. When the parent’s unrealistic
expectations are not met, he or she often reverts to
using the same methods his or her parents used.
This tendency for adults to raise their children in
the same way that they were raised perpetuates the
cycle of family violence. Adults who were victims of
abuse as children frequently abuse their own children
(Biernet, 2000).
Assessment
As with all types of family violence, detection and ac-
curate identification are the first steps. Box 11- 3 lists
signs that might lead the nurse to suspect neglect or
abuse. Burns or scalds are found in 10% of abused
children. The burns may have an identifiable shape,
such as cigarette marks, or may have a “stocking and
glove” distribution, indicating scalding. The parent of
an infant with a severe skull fracture may report
that he or she “rolled off the couch,” even though the
child is too young to do so or the injury is much too
severe for a fall of 20 inches (Ladebauche, 1997).
Children who have been sexually abused may
have urinary tract infections; bruised, red, or swollen
genitalia; tears of the rectum or vagina; and bruis-
ing. The emotional response of these children varies
widely. Often these children talk or behave in ways
that indicate more advanced knowledge of sexual
issues than would be expected for their age. Other
times they are frightened and anxious and may either
cling to an adult or reject adult attention entirely.
The key is to recognize when the child’s behavior is
outside what is normally expected for his or her age
and developmental stage. Seemingly unexplained be-
havior, from refusal to eat to aggressive behavior with
peers, may indicate abuse.
The nurse does not have to decide with certainty
that abuse has occurred. Nurses are responsible for re-
porting suspected child abuse with accurate and thor-
ough documentation of assessment data. All 50 statesJohnny, 7 years old, has been sent to the school nurse
because of a large bruise on his face. The teacher says
Johnny is quiet, shy, and reluctant to join games or ac-
tivities with others at recess. He stumbled around with
no good explanation of what happened to his face when
the teacher asked him about it this morning.
The nurse has seen Johnny before for a variety of
bruises, injuries, and even a burn on his hands. In the past,
Johnny’s mother has described him as clumsy, alwaysCLINICALVIGNETTE: CHILDABUSE
tripping and falling down. She says he’s a “daredevil,”
always trying stunts with his bike or Rollerblades or climb-
ing trees and falling or jumping to the ground. She says
she has tried everything but can’t slow him down.
When the nurse talks to Johnny, he is reluctant to
discuss the bruise on his face. He does not make eye con-
tact with the nurse and gives a vague explanation for his
bruise: “I guess I ran into something.” The nurse suspects
that someone in the home is abusing Johnny.Box 11-3
➤ WARNINGSIGNS OFABUSED/
NEGLECTEDCHILDREN- Serious injury, such as fractures, burns, or
lacerations with no reported history of trauma - Delay in seeking treatment for a significant injury
- Child or parent gives a history inconsistent with
severity of injury, such as a baby with contre-
coupinjuries to the brain (shaken baby syn-
drome) that the parents claim happened when
the infant rolled off the sofa - Inconsistencies or changes in the child’s history
during the evaluation by either the child or
the adult - Unusual injuries for the child’s age and level
of development, such as a fractured femur on
a 2 month old or a dislocated shoulder in a
2 year old - High incidence of urinary tract infections; bruised,
red, or swollen genitalia; tears or bruising of
rectum or vagina - Evidence of old injuries not reported, such as
scars, fractures not treated, multiple bruises that
parent/caregiver cannot explain adequately