COMMENT 1 (150 words)
To start, in Wisconsin, all nurses are lawfully-bound Mandated Reporters and must report neglect and/or abuse (Wisconsin Department of Children and Families, 2019). The reporting mechanism can depend on where you work but a rule of thumb is, if you find signs of abuse, you personally report it. In my county, we dial 920-236-4615 and speak to an intake worker, answer all pertinent questions, and let them make recommendations and take over the case (Winnebago County, 2019).
In my opinion, infants are the most vulnerable age of child when it comes to child abuse, as they are completely dependent, cannot verbalize abuse, and spend most of their days sleeping, masking signs of some kinds of abuse. Neglect is abuse in which the child is not receiving adequate nutrition, shelter, supervision, etc.; neglect might be the most obvious form of abuse. Typically these children are dirty, not dressed for the weather, have diaper rash, and have not had appropriate medical attention: immunizations, checkups, etc. (Green, 2018). Neglected children might rank poorly on growth charts or even regress from previous assessments, parents might appear to lack interest in the child, act under the influence, or be just as unkept (Green, 2018).
Physical abuse can also be quite obvious, as evidenced by bruises, cuts, broke bones, scars, abrasions, burns, and bite marks (Archana & Don, 2019). The infant might appear fearful of the parent or any adults due to their poor visual acuity; the parents might have conflicting or inconsistent stories related to the injuries, refer to the infant as evil or in negative ways, report physically disciplining the infant (CDC, 2019). Shaken Baby Syndrome (SBS) is another form of physical abuse, in which the infant is shaken, causing the brain to slosh around in the head, causing brain damage and death. Signs of SBS are lethargy, which can be easy to ignore as infants sleep a majority of the day, colic, seizures, posturing, bulging fontanels, nystagmus, unequal pupils (Green, 2019).
Less common forms of abuse of infants are sexual, medical and emotional abuse. Sexual abuse would be evident by oral, vaginal, or anal trauma, or blood in the diaper; medical abuse evident if the parent appears happy with their sick infant and attention paid by health care workers, unnecessary testing, and unexplained lab results; emotional abuse is probably harder to assess for, infants might be withdrawn or fearful of adults, delayed, and the parent might simply act as though they reject the child (Green, 2019).
Several cultural practices from Eastern (Asian) medicine that can be mistaken for child abuse, two of those practices are Gua Sha and cupping, both of which I have actually used a therapy for back pain. Both practices will be evident by bruising in the area of activity, usually the back, with Gua Sha resulting in longitudinal bruising following the spine and ribcage from rubbing the back with a spoon-like tool; cupping results in many circular bruises on the upper and mid back from glass cups suctioning to the back (Killion, 2017). These practices are believed to draw out toxins, provide pain relief, reduce inflammation, and increase blood flow, resulting in healing (Killion, 2017). These practices are not child abuse, just Eastern treatments that are not well known or prescribed.
Archana, K., and Don, K.R. (2019) Physical signs of child abuse. Drug Invention Today, 11(1), 189-192.
Centers for Disease Control and Prevention. (2019). Violence prevention: preventing child abuse & neglect. Retrieved from https://www.cdc.gov/violenceprevention/childabuseandneglect/fastfact.html
Killion, C. M., (2017). Cultural healing practices that mimic child abuse. Annals of Forensic Research and Analysis, (4)2, 1-4.
Green, S.Z. (2018). Health assessment of the infant. Health Assessment Foundations for Effective Practice. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/bios
Winnebago County. (2019). Child abuse and neglect reporting. Retrieved from https://www.co.winnebago.wi.us/human-services/divisions/child-welfare/child-abuse-and-neglect-reporting
Wisconsin Department of Children and Families. (2019). Mandated child abuse and neglect reporters. Retrieved from https://dcf.wisconsin.gov/cps/mandatedreporters