Nursing Continuing Education

Child Abuse

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This is Your Course on Child Abuse

Course Outline

  • Background
  • Mandatory Reporting
  • New York State Central Register
  • Types of Abuse
  • Risk Factors
  • Protective Factors
  • Assessment
  • Prevention
  • Plan
  • Reporting Contact Information


Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (e.g., clergy, coach, teacher). There are four common types of maltreatment: Physical Abuse, Sexual Abuse, Emotional Abuse, and Neglect

Statistics and Data

  • 683,000 children had cases of child abuse and neglect reported to child protective services (CPS) in 2015
  • 24% of child abuse cases happen in their first year of a child’s life
  • Between 1 in 4 and 1 in 7 children experience some form of child abuse or neglect in their lifetime
  • 1,670 children died from abuse or neglect in 2015
  • The lifetime cost of child abuse/neglect is approximately $124 billion per year

Mandatory Reporting

If you have reasonable cause to suspect abuse or maltreatment, you must report it according to Section 413 of the social services law. Reasonable cause means that you feel that the child may be, based on your experience and training, at risk of harm or danger. The report must be made immediately upon reaching reasonable cause to suspect abuse or neglect. 

When you are off-duty, you are not mandated to report but it is still encouraged as a concerned citizen even outside your professional role. 

Section 419 of social services law provides immunity from liability to mandated reporters so that they can breach patient confidentiality to report suspected abuse. Also, section 422(4)A provides confidentiality to the person who made the report so that the accused cannot obtain the information about who made the report. 

Mandated reporters include the following professions:

  • Social Worker
  • Licensed Creative Arts Therapist
  • Licensed Marriage and Family Therapist
  • Licensed Mental Health Counselor
  • Licensed Psychoanalyst
  • Physician
  • Surgeon
  • Dentist
  • Dental Hygienist
  • Chiropractor
  • Podiatrist
  • Medical Examiner
  • Coroner
  • Osteopathic doctor
  • Optometrist
  • Resident
  • Intern
  • Registered Nurse
  • Physician Assistant
  • Psychologist
  • Mental Health Professional
  • Substance Abuse Counselor
  • Alcoholism Counselor
  • Peace Officer
  • District Attorney, or Assistant District Attorney
  • Police Officer
  • Investigator employed in the Office of the District Attorney or other law enforcement official
  • School Official
  • Social Services Worker
  • Christian Science Practitioner
  • Hospital personnel engaged in the admission, examination, care or treatment of persons
  • Any employee or volunteer in a residential care program for youth, or any other child care or foster care worker
  • Day Care Center Worker
  • Provider of Family or Group Family Day Care
  • Emergency Medical Technicians

New York State Central Register

Since 1973, New York has had the New York State Central Register (SCR) of Child Abuse and Maltreatment. This service is offered 24 hours a day, seven days a week. The New York State Office of Children and Family Services operates this register. 

Types of Abuse

There are Acts of Commission (Child Abuse) and Acts of Omission (Child Neglect).

Acts of Commission (Child Abuse) are words or overt actions that cause harm, potential harm, or threat of harm

Acts of commission are deliberate and intentional; however, harm to a child might not be the intended consequence. Intention only applies to caregiver acts—not the consequences of those acts. For example, a caregiver might intend to hit a child as punishment (i.e., hitting the child is not accidental or unintentional), but not intend to cause the child to have a concussion. The following types of maltreatment involve acts of commission:

  • Physical abuse
  • Sexual abuse
  • Psychological abuse

Acts of Omission (Child Neglect) are the Failure to provide needs or to protect from harm or potential harm.

Acts of omission are the failure to provide for a child’s basic physical, emotional, or educational needs or to protect a child from harm or potential harm. Like acts of commission, harm to a child might not be the intended consequence. The following types of maltreatment involve acts of omission:

  • Physical neglect
  • Emotional neglect
  • Medical and dental neglect
  • Educational neglect
  • Inadequate supervision
  • Exposure to violent environments


PHYSICAL VIOLENCE occurs when pain or harm results toward an infant or child, as is the case with shaken baby syndrome (caused by violent shaking of young infants).

SEXUAL VIOLENCE occurs when sexual contact takes place without consent.

EMOTIONAL VIOLENCE, which includes behavior that minimizes an individual’s feelings of self‑worth or humiliates, threatens, or intimidates.

NEGLECT includes the failure to provide the following:

  • Physical care, such as food, shelter, and hygiene
  • Emotional care and/or stimulation necessary to achieve developmental milestones, such as speaking and interacting with a child
  • Education for a child
  • Needed health or dental care


  • Failure to provide for the needs of a vulnerable person when adequate funds are available
  • Unpaid bills when another person is managing the finances
  • Theft of or misuse of money or property

Risk Factors

Individual Risk Factors of Victims:

  • Children younger than 4 years of age
  • Special needs that may increase caregiver burden (e.g., disabilities, mental retardation, mental health issues, and chronic physical illnesses)

Risk Factors for Perpetrators of Abuse

Individual Risk Factors:

  • Parents’ lack of understanding of children’s needs, child development and parenting skills
  • Parents’ history of child maltreatment in family of origin
  • Substance abuse and/or mental health issues including depression in the family
  • Parental characteristics such as young age, low education, single parenthood, large number of dependent children, and low income
  • Nonbiological, transient caregivers in the home (e.g., mother’s male partner)
  • Parental thoughts and emotions that tend to support or justify maltreatment behaviors

Family Risk Factors

  • Social isolation
  • Family disorganization, dissolution, and violence, including intimate partner violence
  • Parenting stress, poor parent-child relationships, and negative interactions

Community Risk Factors

  • Community violence
  • Concentrated neighborhood disadvantage (e.g., high poverty and residential instability, high unemployment rates, and high density of alcohol outlets), and poor social connections.

Protective Factors

Protective Factors for Child Maltreatment

Protective factors buffer children from being abused or neglected. These factors exist at various levels. Protective factors have not been studied as extensively or rigorously as risk factors. However, identifying and understanding protective factors are equally as important as researching risk factors.

There is scientific evidence to support the following protective factors:

Family Protective Factors

  • Supportive family environment and social networks
  • Several other potential protective factors have been identified. Research is ongoing to determine whether the following factors do indeed buffer children from maltreatment.

Family Protective Factors

  • Nurturing parenting skills
  • Stable family relationships
  • Household rules and child monitoring
  • Parental employment
  • Adequate housing
  • Access to health care and social services
  • Caring adults outside the family who can serve as role models or mentors

Community Protective Factors

  • Communities that support parents and take responsibility for preventing abuse

Individual Assessment for Violence

Individual Risk Factors for Violence

  • History of being abused or exposure to violence
  • Low self‑esteem
  • Fear and distrust of others
  • Poor self‑control
  • Inadequate social skills
  • Minimal social support/isolation
  • Immature motivation for marriage or childbearing
  • Weak coping skills

Recognizing Potential Child Abuse/Neglect

  • Unexplained injury or injuries
  • Unusual fear of the nurse and others
  • Injuries/wounds not mentioned in history
  • Fractures, including older healed fractures
  • Presence of injuries/wounds/fractures in various stages of healing
  • Bite marks
  • Handprint bruising
  • Cigarette or immersion burns
  • Robe or belt marks
  • Subdural hematomas
  • Trauma to genitalia
  • Malnourishment or dehydration
  • General poor hygiene or inappropriate dress for weather conditions
  • Parent considers child to be a “bad child”

Accidental injuries usually occur along the most bony areas (knees, shins, elbows), whereas suspicious bruising can be seen in places like the inner thighs, stomach, feet, hands, back, buttocks, neck and back of arms and legs. 

Multiple new and healed rib fractures


Community Assessment

Social and Community Violence Risk Factors

  • Work stress
  • Unemployment
  • Media exposure to violence
  • Crowded living conditions
  • Poverty
  • Feelings of powerlessness
  • Social isolation
  • Lack of community resources (playgrounds, parks, theaters)

Strategies to Reduce Societal Violence

Primary Prevention

  • Teach alternative methods of conflict resolution, anger management, and coping strategies in community settings.
  • Organize parenting classes to provide anticipatory guidance of expected age‑appropriate behaviors, appropriate parental responses, and forms of discipline.
  • Educate clients about community services that are available to provide protection from violence.
  • Promote public understanding about the aging process and about safeguards to ensure a safe and secure environment for older adults in the community.
  • Assist in removing or reducing factors that contribute to stress by referring caretakers of older adult clients to respite services, assisting an unemployed parent in finding employment, or increasing social support networks for socially isolated families.
  • Encourage older adults and their families to safeguard their funds and property by getting more information about a financial representative trust, durable power of attorney, a representative payee, and joint tenancy.
  • Teach individuals that no one has a right to touch or hurt another person, and make sure they know how to report cases of abuse.

Secondary Prevention

  • Identify and screen those at risk for abuse and individuals who are potential abusers.
  • Assess and evaluate any unexplained bruises or injuries of any individual.
  • Screen all pregnant women for potential abuse. This might be the one time in some women’s lives that they can access the health care system on a regular basis.
  • Refer sexual assault or rape survivors to a local emergency department for assessment by a sexual assault abuse team. Caution the client not to bathe following the assault because it will destroy physical evidence.
  • Assess and counsel anyone contemplating suicide or homicide, and refer the individual to the appropriate services.
  • Support and educate the offender, even though a report must be made.
  • Assess and help offenders address and deal with the stressors that can be causing or contributing to the abuse, such as mental illness or substance use.
  • Alert all involved about available resources within the community.
  • Advocate for legislation designed to assist older adult independence and caregivers and to increase funding for programs that supply services to low‑income, at‑risk individuals.

Tertiary Prevention

  • Establish parameters for long‑term follow‑up and supervision.
  • Make resources in the community available to survivors of violence (telephone numbers of crisis lines and shelters).
  • If court systems are involved, work with parents while the child is out of the home (in foster care).
  • Refer to mental health professionals for long‑term assistance.
  • Provide grief counseling to families following the death of a family member to suicide or homicide.
  • Develop support groups for caregivers and survivors

Caring for Clients Who Experience Violence

  • Build trust and confidence with a client.
  • Focus on the client rather than the situation.
  • Assess for immediate danger.
  • Provide emergency care as needed.
  • It is NOT the job of the nurse to interrogate or investigate, reasonable cause is all that is needed to report to the agencies who will  investigate. 
  • If you suspect with reasonable cause that abuse may have occurred, complete mandatory reporting, following state and agency guidelines.

Contact Information

Each state has an agency designated to receive reports, it is usually child protective services (CPS). To determine who to report to, you can call the national hotline 1-800-4-A-CHILD

Post Test:

QIDs 65847, 65846, 65843, 65841, 65840, 65838


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  12. U.S. Department of Health and Human Services. Administration on Children, Youth and Families, Children’s Bureau. 2016. Child maltreatment 2014 [online] Available from:
  13. Leeb RT, Paulozzi L, Melanson C, Simon T, Arias I. Child Maltreatment surveillance: uniform definitions for public health and recommended data elements, version 1.0. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2008.
  14. Image from National Institute of Health (National Institute of Health) [Public domain or Public domain]
  15. Image from One Child International Inc


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