Pediatric nurses: On the front lines in dealing with child abuse

In 2014, more than 65,000 reports of child abuse were filed with Texas Child Protective Services (CPS).

This comes as no surprise to Kathryn Sanders, a clinical assistant professor of nursing at the Texas A&M Health Science Center College of Nursing.

From the day she started working as a pediatric nurse 20 years ago, Sanders says she was regularly confronted with cases of child abuse, either in the form of physical abuse, or neglect, which can include not providing children with the food or medications they need.

“One of the worst cases I ever saw was an infant who had been crawling on the floor and put something in his mouth,” Sanders recalls. “It turned out to be his mother’s crack cocaine.”

Whether they are working in hospital emergency rooms or serving as school nurses, nurses are often on the front lines of dealing with child abuse. Sanders has filed reports with CPS, talked to investigators during the course of their investigations, and even testified in court when charges were brought against the parents.

Part of Sanders’ job now as a faculty member at the Texas A&M College of Nursing is to train future nurses how to recognize the signs and symptoms of child abuse, which can often be very subtle. Clues that there might be abuse going on include children who regularly have headaches or stomach aches caused by stress, children who display bruises in uncommon sites and children who become more withdrawn when a certain person comes into the room.

“Early identification is where nurses can really make a difference and hopefully get some early interventions to the family,” Sanders says.

But Sanders says nurses who deal with child abuse on a daily basis – such as those who work in pediatric hospitals – should have additional training on top of what they receive during their pediatric rotation in nursing school.

“These nurses really need a lot more understanding of the forensic side of child abuse,” she says.

That’s why the Texas A&M College of Nursing is pursuing plans to develop a comprehensive forensic nursing program for the state. Forensic nurses have specialized training in providing a medical forensic examination and documenting injuries such as those related to child abuse, elder abuse, sexual abuse and domestic violence. They also learn how to interview victims of abuse and provide testimony in court.

“Forensic nurses are much more adept at interviewing children and parents in a way that is going to assist in planning care and providing better evidence,” Sanders says.

Sanders says there are not enough forensic nurses to help with child abuse cases in Texas, especially in the rapidly growing Central Texas area. She regularly leads nursing students from the Texas A&M Health Science Center Round Rock campus through clinical experiences at hospitals in Austin, where they may see victims of sexual assault, for example, having to wait in an emergency room for several hours before a sexual assault nurse examiner is available. A major goal of forensic nurses is to provide care for children in a timely manner, in a child-friendly atmosphere.

Sanders says having more forensic nurses would also serve as a valuable resource for other nurses.

“We give our students a basic understanding of child abuse, but if you are in a situation where you are confronted with it, you need to have a good resource and a good support person,” she says.

But in the end, it is all about making sure that children who have been abused get the help they need.

“Forensic nurses can deal with the forensic aspect of a case while the other nurses step back and take care of the child,” Sanders says.