Child Abuse and Neglect

Are you familiar with the key question that all healthcare professionals should ask themselves when suspicious of potential child abuse or neglect? Test yourself with the following patient scenarios:

You are the triage nurse in the Emergency Department. A young mother arrives in your department with her two month old male infant. On exam, you notice bruising on the upper arms and face. Some of the bruises are lighter in color. You ask mom what happened and she tells you her baby rolled off the change table. Does this make sense?

Here’s a hint: what do you remember about milestones for growth and development?  Have you already guessed? This infant has not reached the three month milestone to roll over (this occurs around 3 months of age). If an injury just doesn’t seem right, always ask yourself: Does the history explain the injury? If this infant was 5 months old could this be possible? It’s still suspicious, but possible; further investigation is warranted.

Imagine that parents bring in a 9 month old infant. You notice multiple bruises on the back and torso. Parents state the child fell down the stairs. Ask yourself this question: Does the history explain the injury? Think about it. How many 9 month old children have the ability to walk to the stairs? They are too young to walk (most children do not begin to walk until about 12 months of age). Children at 12 months are usually barely beginning to cruise around; you should only expect to see a few bumps and bruises; mostly to the lower legs and shins. Further investigation is required.

Whenever you see a child under the age of one year with bruising, remember that “those that don’t cruise, rarely bruise”. Sometimes bruising can occur with bleeding disorders or other health problems that have yet to be diagnosed, so avoid labeling a child as being abused until all the information has been collected. As a healthcare professional, you are a mandated reporter, so if you are concerned that child abuse might be occurring, you must report it. For more information about child abuse visit Child Welfare Information Gateway at: http://www.childwelfare.gov/pubs/reslist/rl_dsp.cfm?rs_id=5&rate_chno=11-11172