Cover image for Nursing approach to the evaluation of child maltreatment
Title:
Nursing approach to the evaluation of child maltreatment
Author:
Giardino, Eileen R.
Publication Information:
St. Louis : G.W. Medical Pub., [2003]

©2003
Physical Description:
xxvii, 480 pages : illustrations (chiefly color) ; 25 cm
Language:
English
Subject Term:

Electronic Access:
Table of contents http://www.loc.gov/catdir/toc/ecip043/2003009800.html
ISBN:
9781878060518
Format :
Book

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Summary

Summary

Nursing Approach to the Evaluation of Child Maltreatment provides the information, nurses need to identify and accurately interpret the signs of maltreatment and then report it in a specific manner. Presented in 16 chapters comprising three major sections - ""The Problem,"" ""Approaches to Patient Care,"" and ""Special Issues"" - the areas of physical abuse, sexual abuse, and neglect are extensively addressed. Each chapter is structured to give a general overview of the topic area, followed by a detailed treatment plan relevant to the specific types of abuse. In addition, each chapter includes easy-to-use checklists, examination hints, and flow charts for ready access to important information. Edited by a nurse and a paediatrician, with chapter contributions by experts in the various fields of child maltreatment, this handy reference is a must-have for every nurse and nurse practitioner who may be confronted with possible child abuse. It clearly illustrates what is and what is not abuse and identifies the most common types of child abuse, as well as uncommon but possible causes. The steps to be taken when interviewing the child and the details to be addressed in performing a physical examination in a suspected abusive situation are also provided.


Author Notes

Eileen R. Giardino is a nurse practitioner and an associate professor at La Salle University School of Nursing in Philadelphia, Pa.
Angelo P. Giardino is the associate chair for Pediatrics and the medical director for Child Abuse Services at St. Christopher's Hospital for Children in Philadelphia, Pa, and is associate professor of Pediatrics at Drexel University College of Medicine


Table of Contents

Part 1 Overview
Chapter 1 The Problem of Child Abuse and Neglectp. 1
Incidence: Scope of the Problemp. 1
Fatalitiesp. 1
Children With Disabilitiesp. 4
Costs of Maltreatmentp. 4
Definitions of the Problemp. 6
Categories of Maltreatmentp. 6
Physical Abusep. 6
Sexual Abusep. 6
Emotional and Psychological Abusep. 8
Child Neglectp. 8
Legal, Institutional, and Personal Definitions of Abusep. 9
The Child Abuse Prevention and Treatment Actp. 9
The Impact of Physical Abuse and Neglectp. 10
Conceptual Frameworksp. 10
The Epidemiological Frameworkp. 11
The Ecological Frameworkp. 11
Longitudinal Progression Model for Child Sexual Abusep. 11
Engagement Phasep. 12
Sexual Interaction Phasep. 12
Secrecy Phasep. 12
Disclosure Phasep. 12
Retraction Phasep. 13
Traumagenic Dynamics Model for Child Sexual Abusep. 13
The Role of the Nurse in Child Abuse and Neglectp. 15
Mandated Reportingp. 15
Dealing With Child Maltreatmentp. 15
Research Perspectives on Child Abuse and Neglectp. 16
Summaryp. 16
Referencesp. 16
Chapter 2 Presentation and Overview of the Evaluation of Child Maltreatmentp. 21
Overview: Presentations and Evaluationp. 22
Physical Abusep. 22
Differentiating Accidental From Inflicted Injuriesp. 24
Bruisesp. 25
Burnsp. 27
Skeletal Fracturesp. 30
Central Nervous System Injuryp. 33
Child Fatalityp. 34
Sexual Abusep. 36
Nonspecific Behavioral Complaintsp. 38
Nonspecific Genital Complaintsp. 39
Neglectp. 42
Provisional Neglectp. 43
Developmental Neglectp. 43
Supervisional Neglectp. 44
Summaryp. 44
Referencesp. 45
Part 2 Healthcare Evaluation
Chapter 3 History and the Healthcare Interviewp. 49
History and Interviewing in Cases of Suspected Physical Abuse or Neglectp. 50
Warm-up and Ground Rulesp. 51
Specific History of Injuryp. 52
Neglectp. 53
History and Interviewing in Cases of Suspected Sexual Abusep. 54
Obtaining Information From Caregiversp. 55
Gathering Medical History From the Childp. 58
Establishing Rapportp. 58
Eliciting General Health Concernsp. 60
Inquiring About Sexual Abusep. 61
Providing Closurep. 62
Developmental Considerationsp. 63
Questioning Preschool-Age Childrenp. 63
Questioning School-Age Childrenp. 64
Questioning Adolescentsp. 64
Documentationp. 65
Taking Actionp. 66
Summaryp. 67
Referencesp. 67
Chapter 4 The Physical Examination in the Evaluation of Suspected Child Maltreatment: Physical Abuse and Sexual Abuse Examinationsp. 69
Goals and Focusp. 70
Evaluation Versus Investigationp. 71
The Physical Examination in Child Maltreatment Evaluationsp. 72
Professional Knowledge About Child Abuse Evaluationsp. 73
General Issuesp. 74
Stress and Distress Regarding the Evaluationp. 74
Inspection of Child's General Appearancep. 75
Specific Issues Related to the Examination for Suspected Physical Abusep. 75
Accidental Versus Inflicted Injuryp. 75
Skin Injuriesp. 76
Bruisingp. 77
Physical Examination of Bruisesp. 77
Patterned Injuriesp. 78
Dating of Bruise Injuriesp. 79
Related Injuriesp. 79
Burnsp. 80
Pathophysiologyp. 80
Relationship of History to Physical Examination of Burnsp. 81
Physical Examination of Burnsp. 82
Characteristics of the Burn: Accidental Versus Inflictedp. 82
Skeletal Injuriesp. 87
Relevant Historyp. 88
Patterns of Fractures in Abusep. 88
Radiographic Evaluationp. 89
Guidelines for Imagingp. 90
Thoracic and Abdominal Injuriesp. 90
Evaluation and Treatmentp. 90
Examination of the Headp. 91
Basic Types of Head Injuriesp. 91
General Principlesp. 91
Shaken Baby Syndromep. 93
Presenting Signs and Symptomsp. 94
Physical Examinationp. 95
Radiographic Evaluation of Head Injuryp. 96
Mouth and Teethp. 96
Poisoningp. 96
Physical Examinationp. 97
Sexual Abuse Evaluationp. 97
Time Frame for Forensic Examination in Sexual Abusep. 103
Examination Within 72 Hoursp. 103
Examiner Expertise With the Sexual Abuse Examinationp. 104
Knowledge Base of Practitioners in Child Sexual Abuse Findingsp. 104
Stress With Sexual Abuse Evaluationsp. 105
Settingp. 105
Preparing the Child for the Interview and Physical Examinationp. 106
Use of a Colposcope in the Anogenital Examinationp. 107
Position for Genital Evaluationp. 107
Anatomy and Terminology in Child Sexual Abusep. 108
Genital Examinationp. 109
Evaluation of the Hymenp. 112
Rectal Examinationp. 114
Differential Diagnoses for Child Sexual Abusep. 115
Photographyp. 115
Summaryp. 119
Appendix I Genital Evaluation Protocol Scriptp. 120
Appendix II Genital Examination Distress Scalep. 123
Appendix III Abuse and Neglect Formsp. 124
Referencesp. 130
Chapter 5 Laboratory Findings, Diagnostic Testing, and Forensic Specimens in Cases of Child Sexual Abusep. 137
Evidence Collectionp. 138
Evidence Collection Kitsp. 138
Clothingp. 139
Evidence Present on the Skinp. 140
Oral, Anal, and Vaginal Specimensp. 141
Blood Specimensp. 142
Hair Samplesp. 142
Identification of Motile Spermp. 142
Bite Marksp. 143
Forensic Photographyp. 144
Forensic Colposcopic Photographyp. 146
Chain of Custodyp. 148
Laboratory Testing of Evidencep. 148
Detecting the Presence of Seminal Fluidp. 149
Blood and Salivap. 150
DNA Profilingp. 150
Collecting Samples for Sexually Transmitted Disease Testingp. 150
Gonorrheap. 151
Chlamydiap. 152
Herpes Simplexp. 152
Serology Testingp. 152
Conclusionp. 152
Appendix Evidence Collection and Forensic Photographyp. 153
Referencesp. 157
Chapter 6 Sexually Transmitted Diseases in the Setting of Maltreatmentp. 159
When to Test for STDs in the Setting of Suspected Maltreatmentp. 164
Asymptomatic Versus Symptomatic Infectionsp. 167
Specific Infectionsp. 168
Bacterial Vaginosisp. 168
General Overview and Epidemiologyp. 168
Clinical Findingsp. 170
Diagnosisp. 170
Treatment and Follow-upp. 171
Chlamydiap. 177
General Overview and Epidemiologyp. 177
Symptomsp. 178
Prepubertal Childrenp. 178
Adolescentsp. 178
Clinical Findingsp. 179
Prepubertal Childrenp. 179
Adolescentsp. 179
Diagnosisp. 180
Prepubertal Childrenp. 180
Adolescentsp. 180
Treatment and Follow-upp. 180
Gonorrheap. 180
General Overview and Epidemiologyp. 180
Symptoms and Clinical Findingsp. 183
Prepubertal Childrenp. 183
Adolescentsp. 183
Diagnosisp. 184
Treatment and Follow-upp. 184
Pelvic Inflammatory Diseasep. 185
General Overview and Epidemiologyp. 185
Clinical Findingsp. 185
Diagnosisp. 185
Treatment and Follow-upp. 185
Human Papillomavirusp. 188
General Overview and Epidemiologyp. 188
Clinical Findingsp. 189
Prepubertal Childrenp. 189
Adolescentsp. 190
Diagnosisp. 191
Treatment and Follow-upp. 191
Herpes Simplex Virusp. 192
General Overview and Epidemiologyp. 192
Clinical Findingsp. 192
Prepubertal Childrenp. 194
Adolescentsp. 194
Diagnosisp. 195
Treatment and Follow-upp. 195
Trichomoniasisp. 196
General Overview and Epidemiologyp. 196
Clinical Findingsp. 198
Prepubertal Childrenp. 198
Adolescentsp. 198
Diagnosisp. 198
Treatment and Follow-upp. 199
Pediculosis Pubisp. 199
General Overview and Epidemiologyp. 199
Clinical Findingsp. 199
Diagnosisp. 200
Treatment and Follow-upp. 200
Syphilisp. 200
General Overview and Epidemiologyp. 200
Clinical Findingsp. 201
Diagnosisp. 202
Treatment and Follow-upp. 203
Human Immunodeficiency Virus/Acquired Immunodeficiency Syndromep. 205
General Overview and Epidemiologyp. 205
Clinical Findingsp. 209
Diagnosisp. 209
Treatment and Follow-upp. 209
Hepatitis B Virusp. 209
General Overview and Epidemiologyp. 209
Symptoms and Clinical Findingsp. 210
Diagnosisp. 210
Treatment and Follow-upp. 210
Summaryp. 210
Referencesp. 211
Chapter 7 Differential Diagnosis: Conditions That Mimic Child Maltreatmentp. 215
Physical Abusep. 216
Bruisingp. 216
Actual Bruisingp. 216
Accidental Bruisingp. 216
Folk Remediesp. 216
Disorders of the Hemopoietic Systemp. 218
Vasculitisp. 219
Pseudobruisingp. 219
Birthmarksp. 219
Dermatological Conditionsp. 219
Toxinsp. 220
Burnsp. 220
Accidental Burnsp. 221
Scaldsp. 221
Patterned Burnsp. 221
Pseudoburnsp. 221
Infectionsp. 221
Chemical Irritantsp. 221
Fracturesp. 223
Accidental Injuryp. 223
Birth-Related Fracturesp. 223
Inherited/Metabolic Disordersp. 226
Infectionsp. 227
Eye Injuriesp. 227
Retinal Hemorrhagesp. 227
Retinal Hemorrhage From Birth Traumap. 230
Traumap. 230
Infectionsp. 230
Hematological Disordersp. 230
Metabolic Disordersp. 230
Intracranial Lesionsp. 230
Subconjunctival Hemorrhagesp. 230
Periorbital Bruisingp. 231
Failure to Thrive and Growth Failurep. 231
Growth Variationsp. 232
Congenital Anatomical Anomaliesp. 233
Congenital and Chromosomal Disordersp. 233
Organ System Disordersp. 233
Cardiovascular Systemp. 233
Endocrine Systemp. 233
Gastrointestinal Systemp. 234
Hematological and Oncological Disordersp. 234
Immunological Systemp. 234
Metabolic Disordersp. 234
Renal Systemp. 235
Respiratory Systemp. 235
Sexual Abusep. 235
Genital and Anal Findingsp. 235
Anogenital Erythema, Excoriation, and Pruritusp. 236
Local Irritationp. 236
Dermatological Disordersp. 237
Infectionsp. 237
Systemic Conditionsp. 238
Anogenital Bruisingp. 238
Local Injuryp. 238
Dermatological Disordersp. 238
Systemic Conditionsp. 240
Anogenital Bleeding and/or Bloody Vaginal Dischargep. 240
Local Irritationp. 240
Dermatological Disordersp. 240
Infectionp. 240
Endocrinological Disordersp. 240
Structural/Neoplastic Disordersp. 242
Nonbloody Vaginal Dischargep. 242
Unusual Anogenital Appearance, Acquired and Congenitalp. 242
Acquired Conditionsp. 242
Congenital Conditionsp. 243
Referencesp. 243
Chapter 8 Clinical Aspects of Child Neglectp. 251
Definition and Conceptual Modelsp. 255
Incidence Statisticsp. 264
Nursing as a Basis for Clinical Practice With Child Neglectp. 265
Neglect in the Healthcare Settingp. 266
Presentationp. 266
Physical Neglectp. 266
Medical Neglectp. 267
Failure to Thrivep. 267
Evaluationp. 268
Generic Screeningp. 270
Specific Screeningp. 270
Physical Neglectp. 270
Medical Neglectp. 271
Failure to Thrivep. 274
Treatmentp. 276
Generic Measuresp. 276
Specific Measuresp. 277
Nursing Interventions for Child Neglectp. 278
The American Nurses Associationp. 279
Conclusionp. 279
Appendix Report of Suspected Neglect Formp. 280
Referencesp. 283
Chapter 9 Documentation of the Evaluation in Cases of Suspected Child Maltreatmentp. 289
General Considerations for the History and Physical Examinationp. 289
Documentation Guidelinesp. 290
Documentation of Consentp. 291
Format of Assessment Documentationp. 291
Documentation of Taped Interviewsp. 292
Documentation of the Historyp. 292
History From the Caregiverp. 293
Documenting Neglectp. 293
Documenting Caregiver-Child Interactionsp. 294
Physical Findingsp. 294
Photographic Documentation of Findingsp. 294
Use of Colposcopep. 299
Forensic Evidence Collectionp. 299
Documenting Conclusions, Opinions, or Diagnoses From the Medical Evaluationp. 299
Documentation of the Treatment and Planp. 300
Reporting Requirementsp. 300
Court Testimony and Documentationp. 302
Depositionsp. 302
Conclusionp. 302
Appendix Child Abuse Evaluation Formp. 303
Referencesp. 305
Part 3 Related Issues
Chapter 10 Mental Health Aspects of Child Survivors of Abuse and Neglectp. 309
Historical Perceptionsp. 311
Stereotypical Beliefsp. 312
Perceptions of Child Abusep. 313
Social Perceptionsp. 313
Mental Health Principles to Keep in Mind During the Abuse Evaluationp. 313
Points to Remember During History Takingp. 313
Points to Remember During Physical Evaluationp. 316
Developmental Levelp. 317
Family Structurep. 317
Lack of Resourcesp. 318
Trauma Response Patternsp. 318
Emotional and Behavioral Aspects: Attempts at Mastery and the Compulsion to Repeat the Traumap. 318
Posttraumatic Stress Disorderp. 318
Emotional and Behavioral Presentationsp. 321
Integrationp. 322
Reenactmentp. 322
Repetitionp. 322
Displacementp. 322
The Issue of Beliefp. 323
Interventionsp. 323
Short-Term Goalsp. 323
Long-Term Goalsp. 324
Summaryp. 325
Referencesp. 325
Chapter 11 Sexual Abuse of Adolescentsp. 331
Epidemiologyp. 331
Sexual Maturityp. 331
Adolescent Risk-Taking Behaviorsp. 332
Dating Violencep. 334
Sexual Abuse of Malesp. 335
Medical Evaluation of Acute Sexual Assaultp. 335
History and Interviewp. 338
Physical Examinationp. 339
Documentationp. 340
Laboratory Evaluationp. 340
Forensic Evidence Collection Kitp. 341
Sexually Transmitted Disease Prophylaxisp. 341
Pregnancy Prophylaxisp. 342
Medical Evaluation of Nonacute Sexual Abusep. 343
Sequelae of Sexual Abusep. 343
Prevention and Anticipatory Guidancep. 346
Summaryp. 346
Referencesp. 346
Chapter 12 Munchausen Syndrome by Proxyp. 349
Historyp. 349
Victim and Perpetrator Classificationp. 350
Medical Historyp. 350
The Multidisciplinary Team Approachp. 351
Documentationp. 352
Hospitalizationp. 353
Covert Video Surveillancep. 353
Parental Profilesp. 357
Outcomesp. 358
Summaryp. 359
Referencesp. 359
Chapter 13 Child Protective Services and Child Abusep. 361
The History of Child Abuse and Neglect Policyp. 361
Child Protective Servicesp. 363
Role of CPS in the Investigation of Child Abusep. 364
Collaboration in the Investigative Processp. 365
Models of Collaboration in Child Abuse Investigationp. 365
Child Advocacy Center Joint Investigationsp. 366
Child Abuse Reportsp. 367
Sources of Reportsp. 370
Process of a Child Protective System Casep. 371
Family Assessmentp. 371
Case Planningp. 372
Case Management and Treatmentp. 374
Evaluation of Family Progress and Case Closurep. 374
CPS and Mandatory Reportingp. 376
What to Reportp. 378
Benefits of Reportingp. 379
Outcomes of CPS Interventionsp. 380
Summaryp. 382
Referencesp. 382
Chapter 14 Legal Issuesp. 385
Mandated Reportingp. 385
Criminal Investigation Processp. 389
The Judicial Setting: Juvenile, Domestic Relations, Criminal, and Civil Courtsp. 390
Juvenile and Child Protection Courtsp. 391
Domestic Relations Court (Family Court)p. 392
Criminal Court: Prosecutionsp. 394
Civil Court: Lawsuitsp. 395
Children as Witnessesp. 395
Professionals in Court as Witnessesp. 396
Conclusionp. 398
Appendix Mandatory Reporters, Statutes at-a-Glancep. 400
Referencesp. 408
Chapter 15 The Relationship Between Domestic Violence and Child Maltreatmentp. 411
Domestic Violencep. 412
Child Abuse and Maltreatmentp. 412
The Link Between Domestic Violence and Child Maltreatmentp. 413
Family Stressors in the Violent Homep. 414
Response Patterns of Children in Violent Homesp. 415
Physical Responsep. 415
Cognitive Responsep. 416
Psychosocial Responsep. 416
Behavioral Responsep. 417
Implications for Nursing Practicep. 417
Pediatric Nursesp. 418
Women's Health Nursesp. 418
Summaryp. 420
Referencesp. 423
Chapter 16 Risks to Children in the Digital Agep. 429
Technology and Its Use in Child Sexual Victimizationp. 429
What Exactly Are the Risks?p. 430
Why Are Children Attracted to the Internet?p. 431
The Technological Generation Gapp. 435
How the Internet Can Be a Potentially Dangerous Place: Predators on the Webp. 435
Tradersp. 435
Travelersp. 436
A Traveler Case Examplep. 437
Case Study Analysisp. 438
What Can Nurses and Health Professionals Do to Minimize Risks?p. 439
Filtersp. 439
Awareness and Risk Assessmentp. 440
How to Handle Disclosure of Online and Offline Victimizationp. 441
What to Do If You Suspect Online Victimizationp. 441
Referencesp. 442
Chapter 17 Prevention of Child Abuse and Neglect: Approaches and Issuesp. 445
Overview of Preventionp. 445
Primary Prevention: Increasing Awarenessp. 446
Secondary Prevention: Nursing's Role in the Detection of Abusep. 446
Tertiary Prevention: Helping Those Already Harmedp. 447
Child Abuse Prevention Strategies for Children, Adults, and Nursing Professionalsp. 447
Child-Focused Abuse Prevention Programsp. 447
School-Based Prevention Programsp. 448
Adult-Focused Prevention Programsp. 448
Home Visiting Programsp. 449
Pregnancy and Abusep. 451
Professional-Focused Prevention Programsp. 451
Mandated Reporting of Abusep. 451
Abuse Preventionp. 452
School Nursesp. 452
Nurses as Collaborators on the Healthcare Teamp. 452
Summaryp. 453
Referencesp. 453