Child abuse

Child abuse: It’s everyone’s business

A forensic nurse discusses the role of physical child abuse, emotional child abuse, sexual child abuse and neglectful child abuse in society
April 11, 2019

April is national child abuse prevention month.

Child abuse and neglect can happen in any family in any neighborhood, regardless of that family’s race, ethnicity or socioeconomic status. Every year, child protective services (CPS) agencies investigate approximately 2 million cases of possible child abuse.

Abused children often struggle to get help

In my 29-year nursing career, I have cared for thousands of children who were suspected of being abused. Many of those children had been unable to find help for years.

I remember a 13-year-old girl who repeatedly told her mother for years that her step-father was sexually abusing her. Her mother never believed nor helped, so her stepfather continued the abuse.

One day, the girl “was done” with the abuse, and took action. She buried every phone in the backyard, except one. Then, she climbed a 10-foot tall tree in the backyard and called 9-1-1. When police arrived, she was still in the tree, and her mother was yelling at her to get down.

The police believed her story and took her to the hospital where I was working as a sexual assault nurse examiner. During her sexual assault examination, I complimented her on her extreme courage in finding help.

Sadly, I see this type of story all too often in my work. Many children remain in abusive situations because the adults—parents, teachers and health care providers alike—around them fail to recognize the symptoms of child abuse. 

Child abuse is everyone’s business

Child abuse can come in many forms. Knowing each type can help us all remain aware.

Physical child abuse. According to the Texas Department of Family and Protective Services (DFPS), physical child abuse is “physical injury that results in substantial harm to the child, or the genuine threat of substantial harm from physical injury to the child.”

These injuries are considered abusive, regardless if the parent or guardian intended to harm the child.

Possible signs of physical abuse:

  • Frequent bruises or cuts without explanation
  • Patterned bruises or burns
  • Absence from school

Sexual child abuse. Sexual child abuse can include touching or penetration of a child’s genitalia, exploitation through child sex trafficking or producing of pornographic images of children, according to the DFPS.

Possible signs of sexual abuse:

  • Sexually transmitted infections
  • Genital or anal injuries
  • Pregnancy
  • Difficulty sitting or walking
  • Sexually explicit comments or behaviors in young children
  • Acting out sexual behaviors on other children

Emotional child abuse. The DFPS defines emotional child abuse as “mental or emotional injury that results in an observable and material impairment in a child’s growth, development or psychological functioning.”

Possible signs of emotional abuse:

  • Developmental delays
  • Caregiver belittling or scapegoating child
  • Absence from school

Neglect. Neglect is defined as the “failure to provide for a child’s basic needs necessary to sustain the life or health of the child, excluding failure caused primarily by financial inability unless relief services have been offered and refused,” according to the DFPS.

Possible signs of neglect:

  • Malnourishment
  • Poor hygiene, or uncleanliness
  • Stealing, hording or begging for food
  • Unmet health care needs such as needing glasses, dental care or general medical care
  • Tardiness or absence from school

How health care can advocate against child abuse

All health care professionals are required to receive a basic education about suspected abuse of children. However, child abuse pediatricians and forensic nurses, specifically, receive extensive, advanced education and training in the recognition and treatment of suspected abuse.

They learn how to provide trauma-informed care, which places the patient and all they endured at the center of treatment. They specialize in recognizing, understanding and responding to the effects of the trauma, while providing the health care to support mental and physical healing.

While all health care professionals can help, child abuse pediatricians and forensic nurses have training specifically for this purpose. Children often undergo laboratory tests, radiological imaging, specific medical interviews and documentation of injuries, which can be an intimidating process for them. They already feel scared and nervous, so a health care professional that knows the intricacies of the mental effects of trauma can help significantly.

Children who are suspected of being sexually abused should have a specialized sexual assault examination completed by a specifically trained sexual assault nurse examiner or forensically trained physician. If the abuse occurred in the last 96 hours, children should be seen by a qualified health care professional immediately for potential evidence collection and preservation. 

Scope of child abuse in Texas

In 2015, the Texas DFPS hotline received 274,448 calls, and they assigned 228,112 of those calls to a child protective services investigator.

In the same year, the Brazos County DFPS—the county where I work as a forensic nurse—completed 1,038 child abuse investigations. Of those investigations, they confirmed 229 cases as “reason to believe” that abuse or neglect occurred. These numbers are astounding.

My problem and your problem

All Texans have a duty, by law, to report suspected child abuse to the authorities. If you suspect abuse, you can report to your local law enforcement or to the DFPS. You can contact the DFPS via the Texas hotline (800) 252-5400 or online at this website. However, if you believe anyone is in immediate danger then immediately call 9-1-1.

Between the state and the various charities which help victims of child abuse, abused children have many resources. However, we must identify these children before we can help. It is everyone’s business to recognize child abuse. We have to help those that cannot help themselves.

Clinical Assistant Professor in the Forensic Health Care Program

Laurie Charles, MSN, RN, SANE-A, SANE-P, obtained her master’s degree in Health Care Management & Leadership in 2015. She is an emergency department nurse who began her forensic nursing career in a pediatric hospital where she was a sexual assault nurse examiner (SANE), and then manager of the forensic nursing program for 16 years. In her forensic nursing career, she cared for several thousand patients and oversaw the care of tens of thousands of patients. Additionally, Ms. Charles was a SANE Trainer for the Texas Attorney General, providing education for registered nurses. She has extensive sexual assault patient care experience, but her primary expertise is in child physical abuse/neglect, child sexual abuse/assault and human trafficking. Her current focus in on outreach, providing education and training, with an emphasis on combating human trafficking, for health care and multidisciplinary professionals.

— Laurie Charles, MSN, RN

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