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Post 1. As outlined by Falkner (2018), child abuse is any act or series of acts of commission or omission by a parent or other caregiver that results in harm, the potential for harm, or threat of injury to a child; these acts can be physical, sexual, psychological, or a combination of any of the aforementioned in nature.

Abuse in infants, toddlers, and preschool-aged children is can often be assessed by teachers, nurses during well-visits, doctors, or caregivers that live outside the home when the children present with changes in their normal affect, injuries in various stages of healing, or injuries that are inconsistent with the explanation provided by the parent/caregiver. (Falkner, 2018) Another type of glaring injury common with abuse in this patient population is the greenstick fracture, one commonly seen in the upper extremities that occur from yanking a child in frustration ? typically, ?an accident on a swing set? is used as a cover for these types of injuries.

Once a child enters the school-age years, it can be much harder for nurses and other health care providers to assess and report suspected cases of child abuse and neglect (SCAN). These children are more likely to be victims of emotional abuse, physical neglect, caregiver divorce/separation, witnessing intimate partner violence (IPV), witnessing substance abuse within the home, physical abuse, sexual abuse, and emotional neglect. (Brown et al., 2019) At times, these children may choose to hide the evidence of abuse and neglect to protect the survivor of IPV, or for the shame of the physical neglect suffered at the hands of their abuser (i.e., cover the smell of new body order or hide signs of soiled/dirty clothing). Children at this age can also be psychologically manipulated by their abuser and told they are ?special? and that the abuse needs to be kept ?secret? between the victim & abuser. Warning signs to assess for would be behavioral changes, pulling away from adult contact, avoidance of eye contact, mistrust in adults, dirty/tattered clothing, unkempt hair/fingernails, unwashed teeth/dental carries, sexually inappropriate remarks, and adult caregivers that are overprotective or overbearing during child interviews/assessments.

When assessing for SCAN signs, it is crucial that the nurse look not only at the child but also to remember the family-centered approach to the health care model. At the family level, the critical factor of socioeconomic status and parental characteristics, like behavioral health, can significantly affect the likelihood of SCAN. (Maguire-Jack et al., 2022) IPV often co-occurs with child maltreatment creating a dangerous situation for children who often attempt to protect the survivor. Parental substance abuse is also associated with increased risk for physical and psychological abuse among all age groups, including school-aged children. (Maguire-Jack et al., 2022)

In some cultures, corporal punishment like hitting/slapping to correct unwanted behaviors in children is seen as non-taboo. When assessing children for SCAN, care needs to be had when they approach the nurse stating, ?my mommy/daddy hits me.? Further investigation of the situation may be warranted to see if the child means a smack on the bum vs. severe corporal punishment like being struck repeatedly with great force. This may also be an appropriate time for teaching with the parent(s) about cultural norms in their culture vs. what is acceptable regionally/laws, where we live so that they do not mistakenly get reported, should the child make the same claims in the school system. Let us remember that teachers are often also mandated reporters. Still, they do not have the same skill set in assessing for signs of physical abuse, nor are they allowed to use ?nursing judgment? when reporting SCAN ? they must report every time.

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?????????In NJ, all licensed medical professionals are mandatory reporters and must report SCAN to the local law enforcement and the Department of Children and Families (DCF) immediately. Contact can be made by calling the New Jersey Child Abuse/Neglect Hotline at?1-877-NJ-ABUSE (1-877-652-2873); this number is available 24/7/365. Additionally, if the child is a resident of an institution, a report should be made to the Institutional Abuse Investigation Unit by calling?609-292-0617.

References:

Brown, S. M., Rienks, S., McCrae, J. S., & Watamura, S. E. (2019). The co-occurrence of adverse childhood experiences among children investigated for child maltreatment: A latent class analysis.?Child Abuse & Neglect,?87, 18-27.?
https://doi.org/10.1016/j.chiabu.2017.11.010

Falkner, A. (2018). Age-appropriate approach to pediatric health care assessment. In Grand Canyon University (Ed.),?Health assessment: Foundations for effective practice.?
https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/chapter/2

Maguire-Jack, K., Yoon, S., Chang, Y., & Hong, S. (2022). The Relative Influence of Family and Neighborhood Factors on Child Maltreatment at Critical Stages of Child Development.?Children,?9(2), 163.?
https://doi.org/http://dx.doi.org/10.3390/children9020163

Post 2. Child abuse and maltreatment have the same effect on a child. Child abuse is when people who are supposed to be trusted and take care of the child cause harm intentionally or unintentionally or neglect the child by not providing with the needs. Studies have shown that boys are often more abused than girls, but they do not usually report. (Wan 2021). School-going children can be abused at school physically, sexually, or emotionally and might not speak up because of fear and worrying how the other children may judge them. Corporal punishment can be seen as abuse. Most governments have banned corporal punishment of children in schools. However, this age group are vulnerable and can be neglected by parents or caregivers, failing to send them to school. They can be sexually abused by relatives as well. These children can be abused emotionally if raised in domestic violence families. Nurses can identify sexual abuse by assessing pain, bleeding, or any physiological changes in the genital or perianal region of the child. (da Concei??o, 2021). An abused child can be seen by being withdrawn from reality, physical injuries such as fractures and burns with no proper explanation. Usually, a caregiver who abuses a child will not leave that child in care of a health worker in fear that the child may disclose. The child can even suffer some unexplained fear or anxiety. Coining is an example of cultural health practiced that can be viewed as abuse. Another one is circumcision done by other cultures. In Kentucky anyone who suspects a case of child abuse has a right to report to responsible authorities. At hospitals, a nurse will report to the nurse in charge who will escalate to the relevant people. ?

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References:?

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da Concei??o, M. M., Pereira Gomes, N., Ortiz Whitaker, M. C., Santos da Silva, L., Borges Pizzani Ferreira, I. Q., & de Camargo, C. L. (2021). Signs and symptoms of children?s sexual violence: reports of health professionals.?Revista Enfermagem UERJ,?29, 1?7.?
https://doi-org.lopes.idm.oclc.org/10.12957/reuerj.2021.57289
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Wan, G., Li, L., & Gu, Y. (2021). A National Study on Child Abuse and Neglect in Rural China: Does Gender Matter??Journal of Family Violence,?36(8), 1069?1080.?
https://doi-org.lopes.idm.oclc.org/10.1007/s10896-020-00230-9
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According to CDC among four children, one of them has been abused (Dakota Nurse Connection (DNC), 2021). Physical abuse is one of the abuses which is common in school age children. This can involve causing harm to the child either intentionally or unintentionally. Types of physical abuse include beating and slapping the child (DNC,2021) The school age child can also experience neglect abuse, this involves failing to provide things which are needed to promote activities of daily living such as food, clothes, and bathing. Sexual abuse is also common in these children, and this is when is forced into having intercourse, or touched in a sexual manner and this can also include exposing the child to pornography and adult content (DNC, 2021).?The school aged child can also be abused emotionally, this involves shouting at the child saying demeaning and harsh words or watching their parents fighting and failing to give love to the child. This can cause the child to have psychological trauma and can result in mental illness.

Warning signs can include a child withdrawing into themselves, and some can be aggressive and defensive on touch and school aged children can be afraid to go home. Abused children can also find it difficult to smile and can be abnormally quiet. Bruises all over the body such as cigarettes burns without reasonable explanation can also be a sign of abuse and others can show signs of penetration and sexually transmitted infections. The child may also be disheveled and ??showing signs of hunger (DNC, 2021). Cultural variations that can be misidentified as abuse include failing to take the child to the hospital because of religious and cultural beliefs and treating the child at home using cultural herbs. ?Some cultures promote having birth markings such as Mongolian spots and all these can mimic child abuse. ?The nurse is responsible for doing a thorough assessment and accurately recording all the details and taking pictures to keep evidence. The nurse must maintain the child?s safety and follow the facility protocol which can include reporting to the manager who in turn contacts the police and Child Protective Services (CPS) (Shum 2021). In my state Kentucky, when an individual suspect abuse, they file a CPS report by contacting the Abuse Hotline (800) 752 6200.

References

The Red Flags of Child Abuse. (2021).?Dakota Nurse Connection,?74, 22?26.?
https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=149810101&site=ehost-live&scope=site
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Shum, M., Asnes, A., Leventhal, J. M., Bechtel, K., Gaither, J. R., & Tiyyagura, G. (2021). The Use of Experts to Evaluate a Child Abuse Guideline in Community Emergency Departments.?Academic Pediatrics,?21(3), 521?528.?
https://doi-org.lopes.idm.oclc.org/10.1016/j.acap.2020.11.001

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Post 3. According to CDC among four children, one of them has been abused (Dakota Nurse Connection (DNC), 2021). Physical abuse is one of the abuses which is common in school age children. This can involve causing harm to the child either intentionally or unintentionally. Types of physical abuse include beating and slapping the child (DNC,2021) The school age child can also experience neglect abuse, this involves failing to provide things which are needed to promote activities of daily living such as food, clothes, and bathing. Sexual abuse is also common in these children, and this is when is forced into having intercourse, or touched in a sexual manner and this can also include exposing the child to pornography and adult content (DNC, 2021).?The school aged child can also be abused emotionally, this involves shouting at the child saying demeaning and harsh words or watching their parents fighting and failing to give love to the child. This can cause the child to have psychological trauma and can result in mental illness.

Warning signs can include a child withdrawing into themselves, and some can be aggressive and defensive on touch and school aged children can be afraid to go home. Abused children can also find it difficult to smile and can be abnormally quiet. Bruises all over the body such as cigarettes burns without reasonable explanation can also be a sign of abuse and others can show signs of penetration and sexually transmitted infections. The child may also be disheveled and ??showing signs of hunger (DNC, 2021). Cultural variations that can be misidentified as abuse include failing to take the child to the hospital because of religious and cultural beliefs and treating the child at home using cultural herbs. ?Some cultures promote having birth markings such as Mongolian spots and all these can mimic child abuse. ?The nurse is responsible for doing a thorough assessment and accurately recording all the details and taking pictures to keep evidence. The nurse must maintain the child?s safety and follow the facility protocol which can include reporting to the manager who in turn contacts the police and Child Protective Services (CPS) (Shum 2021). In my state Kentucky, when an individual suspect abuse, they file a CPS report by contacting the Abuse Hotline (800) 752 6200.

References

The Red Flags of Child Abuse. (2021).?Dakota Nurse Connection,?74, 22?26.?
https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=149810101&site=ehost-live&scope=site
.

Shum, M., Asnes, A., Leventhal, J. M., Bechtel, K., Gaither, J. R., & Tiyyagura, G. (2021). The Use of Experts to Evaluate a Child Abuse Guideline in Community Emergency Departments.?Academic Pediatrics,?21(3), 521?528.?
https://doi-org.lopes.idm.oclc.org/10.1016/j.acap.2020.11.001

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Post 4. For child abuse I have chosen abuse of toddlers as there are many signs and symptoms to look out for when you are assessing the child. As with other age groups some of these can be cross in other age groups. Some signs and symptoms may not be apparent some of the ones that are often reappearing for children that are abused is constant bedwetting, fear of parents.(Standford medicine 2022) Some physical signs may include bruising in abnormal areas such as buttocks, back of arms, back of the legs, unexplained head injuries that are not usual for Childs activity. No only do we need to see the physical symptoms but when assessing we must ask parents about injuries that when see. Often when assessing the parents and asked about how certain injuries occurred the parent may change their story on what happened or explain something that was not the same from what they originally explained.

A common cultural practice that is often recognized as child abuse is cao gio or more commonly known as coining. It is practiced mostly in southeastern Asian culture in where the parent may use a coin, spoon or metal cap to make elongated bruising on the skin In this culture this is seen to have medicinal purposes for balance, stimulate blood flow and other health benefits. For western cultures when having an assessment it can look quite severe as may be seen as abuse. Having cultural competency and asking some questions to the the family will indicate that this is simply part of their culture and the parents or grandparents may be using this as part of healing their child.

In my state of Nevada any healthcare related field are required to report any suspected child abuse. The report needs to be made to the Department of children and family services (DCFS) or any law enforcement agency. In the report they must report who they may suspect who has done the abuse. In this report they should include basic information such as name, address, age and sex of the abused child . The name of the parents explanation of the suspected abuse and name of the person suspected of the abuse. All this information needs to be reported immediately no later than 24 hours when the suspected abuse is noticed.

Child Abuse. (2022.).?Signs & symptoms. Child Abuse.?
https://childabuse.stanford.edu/screening/signs.html
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Vitale, S. (2017).?Cultural awareness: Coining and cupping. ClinMed International Library.?
https://clinmedjournals.org/articles/ianhc/international-archives-of-nursing-and-health-care-ianhc-3-080.php?jid=ianhc
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Nevada mandatory reporting requirements regarding … – rainn. (n.d.). , from https://www.rainn.org/pdf-files-and-other-documents/Public-Policy/Legal-resources/2009-Mandatory-Report/Nevada09C.pdf?

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