NRS 434 Topic 2 DQ 1 

Child abuse and maltreatment is not limited to a particular age—it can occur in the infant, toddler, preschool, and school-age years. Choose one of the four age groups and outline the types of abuse most commonly seen among children of that age. Describe warning signs and physical and emotional assessment findings the nurse may see that could indicate child abuse. Discuss cultural variations of health practices that can be misidentified as child abuse. Describe the reporting mechanism in your state and nurse responsibilities related to the reporting of suspected child abuse. 



Re: Topic 2 DQ 1

Child abuse is described as the intentional or unintentional damage (sexually, physically, or emotionally) of any child. Deprivation, ill-treatment, and neglect come under the umbrella of child abuse. Unexplained bruises and injuries, changes in behavior or dietary patterns, aggressive nature, or remaining silent are the signs of abuse. Unfortunately, child abuse is still prevalent across the world, especially in the United States. In 2019, there were approx 650000 documented occurrences of child abuse, with neglect being the most frequent kind of maltreatment in the United States. Child abuse knows no gender discrimination and the rates are almost similar between boys and girls. There is a positive relationship between official child abuse and environmental poverty in all racial/ethnic groups (Kim & Drake, 2018). 

Child abuse among toddlers is very common. They are prone to physical, emotional, and sexual abuse. The signs of physical abuse are children returning home with unexplained injuries, bruises, abrasions, cuts, bite marks, or other physical signs. Repeated injuries of any kind might be a red flag. If there are changes in their typical behavior, such as being very irritable, anxious, furious, or silent, child abuse can be suspected. The signs of sexual abuse are genital discomfort, bruising in the genital areas, itching, bleeding, frequent urinary tract infections, and trouble walking or sitting due to genital or anal discomfort. Emotional abuse can be identified when the child exhibits signs of behavioral issues or changes, such as avoiding a parent’s attention, becoming excessively angry or despondent. Abused children frequently exhibit extreme behavior. 

The nurse by taking a proper history from the child and parents and observing the signs as mentioned above can rule out abuse. 

Many cultural practices are prevalent in various countries and can be misidentified as abuse. Coining is practiced in South East Asian countries in which the kin that has been greased with oil is scraped with a ceramic spoon, a worn coin (Vitale & Prasad, 2017). Moxibustion is another traditional Chinese therapeutic technique that originated in Asian medicine and included burning rolled pieces of moxa plant (Killon, 2017). 

In my state (Florida), various abuse hotlines, toll-free numbers function 24 hours a day with the availability of counselors. The person reporting can contact and submit the details of the abuse. The complainant can register the complaint on also. 



Killion, C. M. (2017). Cultural healing practices that mimic child abuse. 

Kim, H., & Drake, B. (2018). Child maltreatment risk as a function of poverty and race/ethnicity
in the USA. International journal of epidemiology, 47(3), 780-787. 

Vitale, S. A., & Prashad, T. (2017). Cultural awareness: coining and cupping. Int Arch Nurs Health Care, 3(3), 080. 

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Hello Mireille, 

I do agree with you that child abuse is still prevalent in the US with approximately 4.4 million reported cases annually by the American Society for Positive Care of Children annually (Cooley & Taussig, 2021). However, some 3.5 million cases go unreported annually. Of the 4.4 million cases reported about 3.4 million received prevention and post response services. Socio-economic factors are the key indicators of such cases of child abuse happening. The cases are common in families of lower income and one or both parents abuse drugs (Tarantola, 2018). Addiction to use of prescription drugs or other hard drugs have been strongly linked to emotional instability and such parents have shown greater possibilities of mistreating their children from early age onwards. The cases of child abuse know no gender as both boys and girls are abused in equal measure. It is in the adolescent stage that the child strongly manifests the symptoms of child abuse (Li et al., 2021). At this age those abused may become extremely aggressive with high emotions that can be self-destructive is not well managed. However, girls are susceptible to forms of abuse related to either sexual exploitation or child sex-trafficking. From the year 2018, 29 states have reported about 900 unique cases of child sex trafficking. The majority of the victims, about 90 percent were girls.  


Cooley, J. L., & Taussig, H. N. (2021). Anger and Attention Problems as Mechanisms Linking Maltreatment Subtypes and Witnessed Violence to Social Functioning Among Children in Out-of-Home Care. Child Maltreatment, 107755952110389. 

Li, W., Yang, J., Gao, L., & Wang, X. (2021). Childhood Maltreatment and Adolescents’ Aggression: A Moderated Mediation Model of Callous-Unemotional Traits and Friendship Quality. Child Maltreatment, 107755952110465. 

Tarantola, D. (2018). Child Maltreatment: Daunting and Universally Prevalent. American Journal of Public Health, 108(9), 1119–1120. 


Re: Topic 2 DQ 1

Infant and toddler abuse are very prevalent type of abuse that we see in children. Child abuse can include physical, sexual, or psychological abuse, or a combination of any of the three. It is important to access signs and symptoms of abuse in children because they might have effects later. Abuse might occur from home through caregivers or close family members. Risks associated with abuse of any kind include poverty, mental illness, and alcohol or substance abuse (Ho, Bettencourt & Gross, 2017). Toddlers who ae abused physically will have unexplained bruises, abrasions, burns, cuts, broken bones, black eyes, bite marks and other injuries that cannot be well accounted for 

Emotionally this child will be very withdrawn and scared of their caregiver. They will have behavioral problems like acting angry and depressed, they will sometimes act very aggressively and in a demanding manner. Behavioral signs that could be indicative of abuse may include fearfulness, inappropriate sexual behavior, abnormal or irrational fears, and social withdrawal. (Lee, Lindberg, Frasier, & Hymel,2021). Doing a thorough assessment will help in identifying any abuse suspicions. The victims and caregivers in this case will be very reluctant to provide any information therefore Nurses should be able to make a judgement of their assessments and follow the correct reporting mechanism of suspected child abuse according to their state laws. 

Cultures vary differently and what is acceptable in one culture might not be acceptable in another one. Some cultures spank their kids as a form of discipline and it is acceptable to them, other cultures will view that as abuse. Some cultures practice coining as a form of treating many illnesses but this could be mistaken for abuse. (Tan, & Mallika 2011). It is important to be culturally sensitive before making conclusions on about child abuse. It is our ethical duty as nurses to report child abuse, Ohio has a hotline that is confidential for reporting suspected child abuse. 



Ho, G. W. K., Bettencourt, A., & Gross, D. A. (2017). Reporting and identifying child physical abuse: How well are we doing? Research in Nursing and Health, 40(6), 519-527. doi:10.1002/nur.21818 

 Lee, G. S., Lindberg, D. M., Frasier, L. D., & Hymel, K. P. (2021). A changing history: When is it a red flag for child abuse? Child Abuse & Neglect, 117. 

TAN AK, & MALLIKA PS. (2011). Coining: An Ancient Treatment Widely Practiced among Asians. Malaysian Family Physician, 6(2&3), 97–98. 



Hello ELA,  

I do agree with you that child abuse cases in the US occurs in many varied forms ranging from physical abuse to psychological one. Preventing child abuse and neglect can be accomplished through a variety of methods (Cirik et al., 2017). Primary care programs designed to identify high-risk patients and refer them to community resources, parent education to improve nurturing and increase the use of positive discipline strategies, and psychotherapy to improve caregivers’ coping skills and strengthen the parent-child relationship are examples of specific interventions (Curry et al., 2018). These interventions are provided in a variety of settings, including primary care clinics, schools, and the community. These programs typically entail a professional or paraprofessional (e.g., a peer educator or a community health worker) visiting a family’s home on a regular basis to provide counseling, educational services, or assistance (Molnar et al., 2021). Families are most frequently identified and referred by health care professionals during the prenatal and postpartum periods. Assessing family needs, giving information and referrals, providing clinical care, and strengthening family functioning and positive child-parent interactions are all part of these services. To assist families with young children, all states and the District of Columbia, as well as tribal and territorial governments, offer home visitation programs (Curry et al., 2018) 


Cirik, V., Ciftcioglu, S., Efe, E., Cirik, V., Ciftcioglu, S., & Efe, E. (2017). Preventing child abuse and neglect. Archives of Nursing Practice and Care, 3(3), 064–067. 

Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Grossman, D. C., Kemper, A. R., Kubik, M., Landefeld, C. S., Mangione, C. M., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B. (2018). Interventions to Prevent Child Maltreatment. JAMA, 320(20), 2122. 

Molnar, B. E., Scoglio, A. A. J., & Beardslee, W. R. (2021). Community-Level Prevention of Childhood Maltreatment: Next Steps in a World with COVID-19. International Journal on Child Maltreatment: Research, Policy and Practice, 3(4), 467–481. 



Re: Topic 2 DQ 1 

Infants are particularly at a higher risk of child abuse and maltreatment due to their defencelessness and dependence on others as well as the intricate processes involved in their psychosocial, neurological, and cognitive development (GWIG, 2016). The most common types of abuse among infants include abusive head trauma from aggressive shaking (shaken baby syndrome), physical spanking (with bruises), burning, and falls from throwing or pushing (American Academy of Pediatrics, n.d.). Some of the infant abuses lead to fatalities, and in 78% of the cases, at least one parent is involved in the infant’s abuse (U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, & Children’s Bureau, 2018). 

Warning signs and emotional and physical assessment findings that may indicate child abuse in infants include: ominous watchfulness by the infant, looking away from parent/caregiver, passiveness, withdrawal, being overly compliant, developmental delays, and unaddressed bruises or injury marks in various stages of healing (Ho et al., 2017). In addition, signs of infant abuse may also be exhibited by the parent or adult caregiver, including denial or delay in seeking healthcare for infant injuries, blaming the infant for injuries or being burdensome, and little show of concern for the infant through touches or looks (GWIG, 2016). Some cultural practices that may be misidentified for abuse include the folk healing practice of cupping among some Chinese, Tibetian, and Middle Eastern cultural groups in which dry or wet cups are used for cupping therapy to suction the subcutaneous tissues underneath the skin (Lupariello et al., 2020). 

In the state of Maryland, it is mandatory for registered nurses to report suspected child abuse based on professional judgment, even without proof, and any report made in good faith is immune from civil or criminal liability or penalty (MDHS, 2021). The process involves filing a report (DHR/SSA 180), notifying the local Child Protection Services department, and law enforcement (in the jurisdiction where the incident occurred) within 48 hours following a verbal report to the nursing supervisor. A copy of the DHR/SSA 180 form must also be forwarded to the State Attorney’s office, and the form should contain the name, age, and address of the child and the nature and extent of the abuse or neglect of the child. 


American Academy of Pediatrics. (n.d.). Abusive head trauma (shaken baby syndrome). Retrieved from 

Lupariello, F., Coppo, E., Cavecchia, I., Bosco, C., Bonaccurso, L., Urbino, A., Di Vella, G. (2020). Differential diagnosis between physical maltreatment and cupping practices in a suspected child abuse case. Forensic Sci Med Pathol. 16(1):188-190. doi: 10.1007/s12024-019-00155-w. 

Child Welfare Information Gateway [GWIG]. (2016). Mandatory reporters of child abuse and neglect. Retrieved from 

Ho, G. K., Gross, D. A., & Bettencourt, A. (2017). Universal mandatory reporting policies and the odds of identifying child physical abuse. American Journal of Public Health, 107(5), 709-716. doi:10.2105/AJPH.2017.303667 

Maryland Department of Human Services [MDHS]. (2021). Child protective services. 

U.S. Department of Health & Human Services [USDHHS], Administration for Children and Families, Administration on Children, Youth and Families, & Children’s Bureau. (2018). Child maltreatment 2016. Washington, DC: Author. Retrieved from 



Hello Makafui, 

I do agree with you that infants are at a higher risk of child abuse that goes on undetected or unreported due to their inability to defend themselves. In the end if these cases go unreported and unaddressed, they have profound effects on the development of a child (Curry et al., 2018). This tremendously affects the child up to adult life and effects may persist throughout a lifetime. Maltreatment of children is prevalent, and it has serious health, educational, and behavioral effects (Mathews et al., 2020). It’s critical to know the frequency and features of child maltreatment across the country in order to create and evaluate programs to reduce it. However, it is well established that measuring child maltreatment is not widespread, and that when it is done, it has methodological obstacles. Child maltreatment, in all of its five recognized forms, is a major public health concern. Physical and mental illnesses are caused by proximal and distal pathways, respectively. Immediate physical injuries and conditions include brain injury and failure to thrive, as well as a wide range of psychological disorders such as anxiety, depression, and suicidality. Physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence all have serious consequences, according to research (Guyon et al., 2021). 


Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Grossman, D. C., Kemper, A. R., Kubik, M., Landefeld, C. S., Mangione, C. M., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B. (2018). Interventions to Prevent Child Maltreatment. JAMA, 320(20), 2122. 

Guyon, R., Fernet, M., Dussault, É., Gauthier-Duchesne, A., Cousineau, M.-M., Tardif, M., & Godbout, N. (2021). Experiences of Disclosure and Reactions of Close Ones from the Perspective of Child Sexual Abuse Survivors: A Qualitative Analysis of Gender Specificities. Journal of Child Sexual Abuse, 30(7), 806–827. 

Mathews, B., Pacella, R., Dunne, M. P., Simunovic, M., & Marston, C. (2020). Improving measurement of child abuse and neglect: A systematic review and analysis of national prevalence studies. PLOS ONE, 15(1), e0227884. 

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