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Maltreatment
whether or not a person meant to cause harm, or if injury resulted from excessive discipline or physical punishment
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CAPTA- federal child abuse prevention and treatment act
identifies minimum set of acts or behaviors that constitute maltreatment
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neglect
- most common form of child abuse
- failure of parent to provide for basic needs
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risk factors for neglect
- lack of resources
- ignorance of child's needs
- poor parenting skills
- failure to recognize need for emotional nurturing
- previous CPS contacts
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physical neglect findings
- failure to thrive
- poor personal hygiene
- unclean and inappropriate dress
- poor health care
- no immunizations
- frequent colds or injuries
- dull and inactive
- begging or stealing food
- absenteeism
- finger sucking or rocking
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emotional neglect
acts of omission that could cause serious behavioral, cognitive, emotional, or mental disorders
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clinical manifestations physical abuse
- unexplained burns, bites, bruises, broken bones, black eye
- fading bruises or other marks after school absence
- seems afraid of parents and cries when its time to go home
- pulls back/shies away around adults
- reports of injury by parents
- volunteers conflicting or unconvincing story
- describes child as bad or evil
- uses harsh discipline
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emotional abuse
- pattern of behavior by parent that results in impairment of child's social, emotional, or intellectual functioning
- ignoring
- belittling
- blaming
- isolating
- using harsh, inconsistent punishment
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behavioral manifestations of emotional abuse
- extremes in behavior - overly compliant or demanding, extreme passivity or aggression
- parentified child or inappropriately childish
- delayed physical or emotional development
- hx of attempted suicide
- self mutilation
- detached from parents
- frequently absent from school
- begs or steals
- failure to thrive
- sleep disorders
- enuresis
- anxiety disorders
- rejects child
- acts unconcerned about child/ refuses to help
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sexual abuse
use of persuasion and/or coercion to engage a child in any sexually explicit conduct such as exhibitionism, child pornography, child prostitution, pedophilia, incest, and molestation
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clinical findings of sexual abuse
- bruises, bleeding, lacerations, or irritations of external genitalia
- torn or stained underwear
- pain on urination
- penile discharge
- difficulty walking or sitting
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suggestive behaviors of sexual abuse
- becomes pregnant
- contracts STD
- reports sexual abuse
- anxiety
- substance abuse
- any profound change in personality
- reports nightmares and/or bedwetting
- sudden change in appetite
- sudden emergence in sexually related problems
- presence of sperm
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Suspect sexual abuse if...
- suicidal
- poor relationships with peers
- regressive behavior
- running away from home
- declining in school performance
- unusual odor in genital area
- recurrent UTIs
- pregnancy in young adolescent
- superficial relationships
- indiscriminate relationships with strangers
- parent overly protective or isolates child from other kids esp. opposite sex
- parent is secretive and isolated
- child is jealous and controlling with family members
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Munchhausen syndrome by proxy
illness that one person fabricates or induces in another person
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witnessing violence: infancy
- disrupted attachment
- disrupted routines
- risk of physical injury
- decreased responsiveness
- increased crying
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witnessing violence: preschoolers
- don't feel safe
- irritable
- somatic complaints
- regressive, clingy behaviors
- separation anxiety
- sleep problems
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witnessing violence: school age
- more prone to violence
- blames self for violence at home
- shame, embarrassment
- distracted, inattentive hyper vigilant
- blunted affect
- guarde
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witnessing violence: adolescent
- feeling shame and betrayal
- truancy
- early sexual activity
- substance abuse
- delinquency
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assessment of maltreatment
- critical to identify as early as possible
- thorough physical exam and detailed history
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what to report
- name and address of child and caretakers
- nature and extent of injuries
- name of responsible party
- family composition
- person making report and how to be reached
- actions taken (xrays, photos,etc.)
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primary intervention of child abuse
- prevent by identifying those high risk, provide health teaching, provide supportive services to prevent crisis
- strategies to reduce stress, influence of risk factors, and increase social support, coping skills, and self esteem
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secondary prevention of child abuse
- early intervention in abusive situations
- screen for stress and depression
- support groups
- safe houses
- counseling and education
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tertiary prevention of child abuse
- healing and rehab
- assisting survivors
- empowerment
- individual, family, and group therapy
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