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
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:
Licensed Creative Arts Therapist
Licensed Marriage and Family Therapist
Licensed Mental Health Counselor
Mental Health Professional
Substance Abuse Counselor
District Attorney, or Assistant District Attorney
Investigator employed in the Office of the District Attorney or other law enforcement 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:
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:
Medical and dental neglect
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
ECONOMIC MALTREATMENT includes:
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
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
Family disorganization, dissolution, and violence, including intimate partner violence
Parenting stress, poor parent-child relationships, and negative interactions
Community Risk Factors
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 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
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
Fear and distrust of others
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
Cigarette or immersion burns
Robe or belt marks
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
Social and Community Violence Risk Factors
Media exposure to violence
Crowded living conditions
Feelings of powerlessness
Lack of community resources (playgrounds, parks, theaters)
Strategies to Reduce Societal Violence
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.
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.
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.
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
QIDs 65847, 65846, 65843, 65841, 65840, 65838
The Centers for Disease Control and Prevention (CDC, 2017) (Centers for Disease Control and Prevention [CDC], 2017)
Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (10th ed.). Upper Saddle River, NJ: Prentice-Hall.
Dudek, S. G. (2014). Nutrition essentials for nursing practice (7th ed.). Philadelphia: Lippincott Williams & Wilkins.
Eliopoulos, C. (2014). Gerontological nursing (8th ed.). Philadelphia: Lippincott Williams & Wilkins.
Halter, M. J. (2014). Varcarolis’ foundations of psychiatric mental health nursing: A clinical approach (7th ed.). St. Louis, MO: Saunders.
Hockenberry, M. J., & W ilson, D. (2015) Wong’s nursing care of infants and children (10th ed.). St. Louis, MO: Mosby.
Ignatavicius, D. D., & Workman, M. L. (2016). Medical‑surgical nursing (8th ed.). St. Louis, MO: Elsevier.
Lowdermilk, D. L., Perry, S. E., Cashion, M. C., & Aldean, K. R. (2016). Maternity & women’s health care (11th ed.). St. Louis, MO: Elsevier.
Marquis, B. L., & H uston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application. (8th ed.). Philadelphia: Lippincott Williams & Wilkins.
Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2013). Fundamentals of nursing (8th ed.). St. Louis, MO: Mosby.
Stanhope, M., & Lancaster, J. (2014). Foundations of nursing in the community (4th ed.). St. Louis, MO: Mosby.
U.S. Department of Health and Human Services. Administration on Children, Youth and Families, Children’s Bureau. 2016. Child maltreatment 2014 [online] Available from: http://www.acf.hhs.gov/sites/default/files/cb/cm2014.pdf
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.
Image from National Institute of Health (National Institute of Health) [Public domain or Public domain]
Image from Abusewatch.net One Child International Inc