NRS 434 Describe warning signs and physical and emotional assessment findings the nurse may see that could indicate child abuse

NRS 434 Describe warning signs and physical and emotional assessment findings the nurse may see that could indicate child abuse

NRS 434 Describe warning signs and physical and emotional assessment findings the nurse may see that could indicate child abuse

According to the Department of Social Services Office of Child Abuse Prevention, while all children are at risk of abuse, infants and toddlers are most likely to sustain serious injuries due to their fragility. The mortality rate is highest for children 0-2. The majority of cases reported to Child Protective Services involve neglect, followed by physical and sexual abuse. Unfortunately, there is a lot of overlap among children who are abused, with many suffering a combination of physical abuse, sexual abuse, and/or neglect.

Physical abuse occurs when a child’s body is injured as a result of hitting, kicking, shaking, burning or other show of force. One study suggests that about 1 in 20 children has been physically abused in their lifetime.

Sexual Abuse is any sexual activity that a child cannot understand or consent to. It includes acts such as fondling, oral-genital contact and genital and anal intercourse. It also includes exhibitionism, voyeurism, and exposure to pornography. Studies suggest that up to one in five girls and one in 20 boys will be sexually abused before they are 18 years old. More than 90 percent of child sexual abuse victims know their abuser.

Child negleccan include physical neglect (failing to provide food, clothing, shelter, or other physical necessities), emotional neglect (not providing love, comfort, or affection), and medical or educational neglect (not providing access to needed medical care or education) or supervisory neglect (failure to appropriately supervise). Psychological or emotional abuse results from all of the above, but also can be associated with verbal abuse, which can harm a child’s self-worth or emotional well-being.

Most child abuse occurs within the family. Risk factors include parental depression or other mental health issues, a parental history of childhood abuse or neglect, parental substance abuse and domestic violence.

Child neglect and other forms of maltreatment are also more common in families living in poverty and among parents who are teenagers or who abuse drugs or alcohol.

Signs and symptoms of child abuse for babies ages 0-2 are as follows: non mobile, with an injury, bruises to torso, ears or neck, genital pain, bleeding, or discharge, failure to gain weight or dramatic weight loss, fearful behavior.

As a nurse in Arizona, we are mandated to report all known or suspected abuse. We first notify our nurse leader, followed by a detailed statement to child protective services.

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Thank you for sharing that important information, and let us know how in Arizona child abuse is followed by mandated reporters.

A majority of abuse occurs as a result of neglect at the national level. More than three-fourths of victims (more than 75%) were neglected. Approximately 600,000 children in the United States are abused each year according to statistics. As a result, there is a lot of harm done to children. Girls were more likely than boys to be victims, with a victimization rate of 8.9 percent, and boys with a victimization rate of 7.4. Additionally, American-Indian and Alaskan children are the most likely to be abused. The abuse of a child is often committed by a parent or other relative that the child knows and trusts. It is important to report child abuse to the appropriate authorities if you suspect the abuse is occurring.

National Children’s Alliance. (2023). National Child Abuse Statistics from NCA. National Children’s Alliance.

I can see why child parental substance abuse or alcohol can cause child neglect and maltreatment as it can impair judgment, compromise parenting abilities, and increase the likelihood of abusive behaviors towards children. It’s sad that couples choose to bring a child in this world knowing they are not ready due to their circumstances.

Infants are at a higher risk for physical abuse as they are at their most vulnerable stage of life. The CDC defines physical abuse as the intentional use of physical force that can result in physical injury. Examples include hitting, kicking, shaking, burning, or other shows of force against a child(CDC, 2022).

Signs and symptoms of physical abuse in an infant can include:

·        unexplained abrasions, burns, bites, bruises, broken bones, black eyes, or cuts

·        an injury type or location that does not correlate with the given explanation

·        an injury that does not correlate with capabilities of the infant’s developmental state

·        Seems frightened of the parents and protests or cries when it is time to go home

Signs and symptoms of an abusive parent or other adult caregiver include:

·        Offers conflicting, unconvincing, or no explanation for the infant’s injury

·        Describes the infant as “evil,” or in some other very negative way

·        Uses harsh physical discipline with the infant

·        Has a history of abuse as an infant(Green, 2022)

Healing practices such as coining can be misidentified as child abuse. Coining, also called caogio, is a cultural healing practice used among Vietnamese, Cambodians, and Laotians to bring healing and balance in the realms of the physical, metaphysical, and supernatural. This practice is a form of dermabrasion that uses oils and herbs to rid the body of illness. Even when done properly, marks after the remedy is administered such as rashes or small red lesions can appear on places where the treatment is commonly administered; some believe that the remedy is only effective when marks are seen(Waters-Tozier, 2020). Other types of healing practices that can be masked as physical abuse are moxibustion and the caida de mollera. Although physical abuse signs and symptoms can have a truly justifiable reason, nurses are mandated reporters and must report signs of abuse. In a hospital setting if a nurse suspects a child is being abused they have access to the Hague Protocol which is a screening tool for child abuse or neglect based on certain parental characteristics(Green, 2022). Nurses in California, per the BRN, are required to immediately make a report to local law enforcement agencies. A report by telephone shall be made immediately or as soon as practically possible and a written report shall be prepared on the standard form developed in compliance with state agencies. The completed forms shall be sent to local law enforcement agency within two working days of receiving the information regarding the person(CNPA, 2010). Risk factors that may increase the vulnerability of an infant for abuse include babies with functional or mental disabilities, parents with substance/alcohol abuse or depression issues, poverty, non-biological parents or young parents, and families that have domestic violence issues.


Abuse Reporting Requirements. California Nursing Practice Act – California Board of Registered Nursing. (2010, November).

Centers for Disease Control and Prevention. (2022, April 6). Fast facts: Preventing child abuse & neglect |violence prevention|injury Center|CDC. Centers for Disease Control and Prevention.

Green, S. Z. (2022). Health Assessment: Foundations for Effective Practice.

Waters-Tozier, SA. (2020) Cultural Practices and Values that can Masquerade as Child abuse: A Literature Review and Recommendations for the Forensic Psychologist. J Foren Psy. doi: 10.35248/2475-319X.20.5.160 

 I am in support of very point you mentioned in your presentation about how mental health of children can increase the risk of their vulnerability to child abuse. I would like to talk more on this. Children with mental disabilities face communication challenges, limited understanding, dependence on caregivers, social isolation, and lack of awareness and education. These factors make it difficult for them to recognize abuse and protect themselves. Social isolation can make them more susceptible to abuse, as they have fewer trusted individuals to recognize signs. Lack of awareness and education contributes to underreporting of abuse and failure to implement appropriate safeguards. Prioritizing the protection and well-being of all children, including those with mental disabilities, requires creating supportive environments, providing comprehensive education, and implementing safeguards to prevent and detect abuse early. My friend once told me that a male nurse on night duty always abuse a female client in the group home. Nobody knew about it until he was caught on camera and arrested.


(n.d.). The Arc | For People With Intellectual & Developmental Disabilities.

According to the Child Welfare; child abuse of some degree happens in every culture and society. The definition of abuse or neglect can varies from culture to culture, some parents might called it child discipline, but ultimely  abuse or neglect need to be avoided, by implementing educa