Screening for Child Abuse Samuel Merritt University Primary

Screening for Child Abuse Samuel Merritt University Primary Healthcare I Spring 2012 Alicia Kletter RN MSN FNP

Introduction to Case of “Lola” • 8 -month old little girl • Her mother is my patient in methadone maintenance • I have known the mother 1 year, Lola her whole life • Mother’s boyfriend violent and not the child’s father • After an argument, intoxicated boyfriend took off with 8 -month old Lola • Mother is hysterical, in clinic seeking our help

Introduction & Definition • Child abuse occurs worldwide • Consequences for children may be serious and long term. • Health care providers play essential roles ▫ protecting children through recognition and reporting

Introduction & Definition • Child Abuse Prevention and Treatment Act (1996) ▫ Act or failure to act ▫ Results in death, serious physical or emotional harm, sexual abuse, exploitation, imminent risk of serious harm ▫ Involving a child ▫ By a parent or caretaker • The four major types of child abuse are: ▫ ▫ Physical abuse Sexual abuse Emotional abuse Child neglect

Epidemiology of Child Abuse • 1 million cases substantiated annually by CPS ▫ 17% physical abuse • 2, 500 children die in US each year from abuse ▫ Under age 1 more common • Minority children have higher rates of abuse ▫ Speculation that stereotypes result in more reporting in minority children • Who is abusing children in this country? ▫ Fathers ▫ Mothers’ boyfriends ▫ Female babysitters ▫ Mothers

Risk Factors for Child Abuse • Parental Risk Factors ▫ Young ▫ Single parents ▫ Low education level ▫ Unstable family situation ▫ Drug / alcohol abuse ▫ Psychiatric illness ▫ Abused themselves as children • Environmental Risk Factors ▫ Poverty (? ) ▫ Unstable family situation ▫ Social isolation ▫ Distant / absent extended family ▫ Acceptance that violence is a means of problem solving

Risk Factors for Child Abuse • Victim Risk Factors ▫ Age less than 1 year old ▫ Past history of abuse ▫ Speech / language delay ▫ Congenital anomalies ▫ Hyperactive children ▫ Adopted children ▫ Step children ▫ Failure to thrive

What are Lola’s Risk Factors • • • Age less than 1 year Drug abuse in immediate environment Family violence in her home Poverty (? ) Mother has a boyfriend DO WE NEED TO MAKE A CPS REPORT?

Physical Exam Findings of Abuse • http: //www. medscape. org/ viewarticle/432571_3 • Face most common location for injury • Bruising most common type of injury noted ▫ How can you tell if intentional vs unintentional bruise? • Adult bite marks versus another child

Physical Examination of Lola • Cigarette burns on her back • No other physical injuries noted

Physical Abuse Bruising Locations Suggestive of Abuse Patterns Locations Suggestive Accidental Bruising

Talking to Parents About Abuse • Should tell parents that a report is being made • Stress that it’s for the child’s safety • Expect relief, hysterical denial or even violence • Have a safety plan in place for unaccused parent, child and clinic staff if necessary

Lola’s Case – after the CPS Report • We were threatened by accused abuser • Mother of child also angry about CPS report • She herself is being abused by the accused child abuser • Mother transferred out of our care • I have lost touch with case • How can you protect yourself and your staff after a CPS report is made?

Mandated Reporting • Those who typically have frequent contact with children ▫ Social workers ▫ Teachers ▫ Health care workers ▫ Mental health professionals ▫ Child care providers ▫ Medical examiners ▫ Law enforcement

Few Additional Thoughts • Sexual Abuse in Children ▫ >100, 000 each year in the US ▫ Approx 1% (underestimated? ) ▫ Girls > boys ▫ Can present with variety of nonspecific medical complaints ▫ Do you have the expertise to evaluate & interview possible victim? ▫ Do you have the expertise to collect forensic evidence?

Few Additional Thoughts

Summary • Realize that you have the child’s best interest in mind when making a report • Know your patient demographics and what risk factors for abuse are present • Don’t assume that someone else will report