Statistics from the Australian Institute of Health and Welfare

According to the Australian Institute of Health and Welfare (2017)

One in every 33 children required child protection services in 2015 and 2016. Nursing is one of the occupations that deals with children of all ages on a daily basis. As a result, nurses can intervene and assist in cases of child abuse and neglect in a variety of ways. Child abuse is a problem that has a significant impact on nursing careers and results. A abused child is predisposed to a variety of health concerns, including some that extend into childhood. This paper will look at a case study concerning a 3-month-old girl who was most likely molested. The paper will discuss the dangers that abuse represents to children in regard to wellbeing and development. It will also identify factors in the case study that indicate abuse on a patient. A good understanding of these factors is important in helping a nurse fulfil their professional responsibilities in regard to child abuse.

Potential Impact of Abuse On the Development and Wellbeing of the Infant

Child abuse is associated with negative short-term and long-term effects on the physical and mental wellbeing and development of the child. A child who is disposed to abuse experiences impaired cognitive and socio-emotional growth. Cognitive growth refers to the development a child's learning ability. This ability is usually enhanced as the child grows and interacts with the environment (Nemeroff, 2016). Abuse results in physical injury and pain, making it hard for the child to freely move around and interact with the environment. Therefore, their learning ability is negatively impacted as they concentrate on the pain and ways of evading further injuries that result from abuse. Socio-emotional growth is associated with the process of gaining social and emotional skills. Social skills are gained from interaction with those around the child. A child learns to play, interact, read the emotions of those around them and appropriately react to them as they grow. Results in the study by Nemeroff indicate that abuse separates the child from the aggressor. They live in fear and may void physical and eye contact due to fear of victimization. As the child grows, they become withdrawn from the rest of the society. Children who have suffered abuse may also lack the ability to observe and comprehend the emotions of other people around them.

Physical abuse has the most certain and most observable effects on a child

Head trauma is a common phenomenon associated with child abuse. The injuries are likely to result in blindness and cerebral palsy. Binenbaum & Forbes (2014) notes that in many incidents where child abuse includes head injuries, retinal hemorrhages are diagnosed. Abuse in early childhood, especially infancy, results in deformation and dysfunction of certain parts of the brain. This inhibits cognitive development and the child's language abilities. The fear of recurring abuse leads to hyperarousal as a response in the brain. This overworks the central nervous systems and can be diagnosed as sleep disturbances and hyperactivity. Hyperarousal is a condition that is closely associated with Post Traumatic Stress Disorder. A medic will require a long period of time to diagnose PTSD in an infant since they have to observe factors such as her sleep patterns. The study by Binenbaum & Forbes indicates that retinal hemorrhage is a key symptom that can help medics when examining a child for PTSD.

Child abuse is associated with long-term behavioral effects

That may set in as early as the pre-teenage age into adulthood. According to Vachon et al. (2015), children who experienced abuse are at increased risk of alcoholism, drug abuse and risky sexual behavior. Due to the poor relationship between the children and their parents, the former are more likely to ignore advice when growing up this becoming delinquent during an early age. Such children are more likely to record poor academic performance, teenage pregnancy and low graduation rates (Shepherd et al., 2014). A study by Vachon et al. (2015) on the consequences of child maltreatment revealed that eating disorders, anxiety, substance abuse and depression are some of the common universal behavioral effects of child abuse.

According to Almuneef et al. (2014)

Child abuse is a significant risk factor to chronic diseases. Some of the long-term adverse health risks associated with child abuse include obesity, high blood pressure, heart disease, chronic lung disease and high cholesterol levels. The trauma that the child suffers at the early stages culminates into PTSD and this alters the lifestyle of the victim. Under intense abuse, the factors may laminate and combine resulting in death of the victim.

Factors in Emma's presentation that may indicate that she has been abused

While examining Emma, she is difficult to rouse and remains asleep throughout the whole process. One of the effects of abuse is sleep disturbances. A child who suffers from abuse may not get enough sleep during the normal sleeping hours, which are during the night. Therefore, the body of the child will try and compensate for the lost hours of sleep when it gets relative comfort. In this case, the process of examination may prove more comfortable than the experiences that Emma has undergone under the custody of her parents. The relief that Emma experiences while undergoing examination is an indicator that she has been living in a worse environment. It is likely that a child's attention will be caught by the change in the environment and the new person handling them.

Emma has external bruises on her head and torso. The explanation that her mother gives to this is vague. The mother claims that they are a result of rolling off the couch the previous night. The bruises are oval and this means that they might have been inflicted intentionally. The fact that the mother did not immediately seek medical attention after Emma rolled off the couch may be taken as neglect. Abuse does not only encompass direct infliction of physical and emotional pain but also neglect by those responsible, thus letting the child suffer. The bruises may either be evidence of direct abuse on Emma by her parents or neglect.

While undergoing examination, Emma experiences a seizure and she has to be resuscitated. According to Campbell et al. (2015), one of the main causes of seizure in infants is congenital brain defects. The defects are a result of severe head trauma. An infant like Emma has a weak skeletal system which can hardly protect her brain from trauma when she is hit on the head. Seizures result from nerve damage or problems within the brain cells. The seizures experienced by Emma must have been caused by damage due to the same events that led to the oval bruises at her occiput. It is unlikely that rolling off the couch can lead to such fatal brain injuries. Emma's parents should provide more information that can help in understanding the likely cause of problems within Emma's brain cells.

Since Emma is an infant, an analysis to determine whether she has been under abuse or not will mainly depend on the physiological and behavioural factors. The most visible phenomena in this examination are sleep pattern, injuries and the seizures that she experiences. These three form a basis on which further investigation can be founded.

Professional Responsibilities If Abuse is Suspected

Scenario: You are working in the Emergency Department when Emma, a 3-month-old girl is brought in by her mother Jamie, with a 12-hour history of vomiting and lethargy for investigation. On examination, Emma is difficult to rouse and does not remain awake as you take her vital signs. Emma is noted to have several small, oval shaped bruises to her torso, as well as bruising to the occiput. When asked how the bruises occurred, Jamie is vague, saying that Emma rolled off the couch last night. As you are completing your assessment, Emma experiences a seizure, requiring transfer to the resuscitation bay.

AssignmentQuestion: Discuss the potential impact of abuse on the development and wellbeing of the infant.

Identify factors in Emma's presentation that may indicate that she has been abused, and

describe your professional responsibilities if abuse is suspected.

References

Nemeroff, C. B. (2016). Paradise lost: the neurobiological and clinical consequences of child abuse and neglect. Neuron, 89(5), 892-909.

Binenbaum, G., & Forbes, B. J. (2014). The eye in child abuse: key points on retinal hemorrhages and abusive head trauma. Pediatric radiology, 44(4), 571-577.

Australian Institute of Health Statistics and Welfare. (2017). Child protection in Australia. Retrieved from http://www.aihw.gov.au/child-protection/

Almuneef, M., Qayad, M., Aleissa, M., & Albuhairan, F. (2014). Adverse childhood experiences, chronic diseases, and risky health behaviors in Saudi Arabian adults: A pilot study. Child abuse & neglect, 38(11), 1787-1793.

Campbell, K. A., Olson, L. M., & Keenan, H. T. (2015). Critical elements in the medical evaluation of suspected child physical abuse. Pediatrics, peds-2014.

Vachon, D. D., Krueger, R. F., Rogosch, F. A., & Cicchetti, D. (2015). Assessment of the harmful psychiatric and behavioral effects of different forms of child maltreatment. JAMA psychiatry, 72(11), 1135-1142.

Shepherd, S. M., Luebbers, S., Ferguson, M., Ogloff, J. R., & Dolan, M. (2014). The utility of the SAVRY across ethnicity in Australian young offenders. Psychology, Public Policy, and Law, 20(1), 31.

Lanier, P., Kohl, P. L., Raghavan, R., & Auslander, W. (2015). A preliminary examination of child well-being of physically abused and neglected children compared to a normative pediatric population. Child maltreatment, 20(1), 72-79.

Vachon, D. D., Krueger, R. F., Rogosch, F. A., & Cicchetti, D. (2015). Assessment of the harmful psychiatric and behavioral effects of different forms of child maltreatment. JAMA psychiatry, 72(11), 1135-1142.