Care of the Child and Adolescent

Case Study: Jack’s Physical Abuse

Adverse experiences in childhood could have a long-term influence on a child’s maturation and quality of life (Boullier & Blair, 2018). A number of abnormalities in the structural and functional brain responsiveness, as well as stressors of neurobiological processes, have been related to childhood abuse. The influence of child abuse on physical and mental health has been demonstrated in research studies (Marine & Forbes-Amrhein, 2021).  Although bruising is the prevalent indication of child physiological abuse, nurses might find it difficult to determine whether to be worried about exploitation as well as how to evaluate bruises in this setting (Berkowitz, 2017). This case study assessment will highlight the evidence-based physical responsive assessment methodologies, and focused responsibilities and discuss more adverse childhood experiences utilizing research papers.

Jack is an infant who is just 3 months old, his right femur was fractured. The fracture site was bruised and has a noticeable swelling around the fractured site. He also had oval-shaped small bruises around his ankle and around his left ear. Child bruising is a frequent and generally harmless type of trauma that does not necessitate further study or treatment (Johnson, et al., 2021).  On the other hand, it is uncommon in babies, but it is the most frequent problem in young children who have been severely mistreated. Timely identification of self-inflicted damage might help to avert a much more serious injury in the future (Marine & Forbes-Amrhein, 2021).

In the case of Jack bruising around the site of fracture could be a genuine accident, however, the off-site bruises are the shred of clear evidence that these bruises are not accidental. The chance of an infant getting bruises is directly proportional to his or her level of movement. Bruises are uncommon in babies who have not been crawling, just like Jack who is just 3 months old.

Bruising is seen in under 1% of newborns less than 9 months, contrasted to 40 percent to 90 percent of infants nine months and beyond (McKelvey, et al., 2018).  Bruises or a pattern of bruises in babies can be a sentinel injury indicating the likelihood of existing or prospective exploitation, just like fractures and off-site bruises Jack.  As a result, any inexplicable bruise in a non-mobile youngster should be investigated thoroughly for mistreatment (Johnson, et al., 2021).    Child Abuse And Physical Abuse Assessments Paper

Bruising on the epidermis that portrays an item or structure is often considered as being extremely suggestive of intentional trauma (Narang, et al., 2020). According to evidence-based research, clusters of bruises around Jack’s ankle are common in abused infants and are likely to signify defensive wounds or grasp imprints (Berkowitz, 2017).

All types of emotional and physical ill-treatment, negligence, and abuse resulted in real or potential impairment to the child’s health, maturity, or integrity, according to the World Health Organization (Anda, et al., 2020). Stabilization is the first step in treating an exploited infant, which includes checking the child’s breathing, respiration, and circulatory system (McKelvey, et al., 2018). A full physical assessment is necessary after ensuring that the patient is stabilized. It must be notified when there is a suspect of child abuse in any manner (Berkowitz, 2017). If the pediatric clinic has a child maltreatment expert on staff, their engagement would be ideal.

The Long-Term Impact Of Childhood Abuse

If the child is examined in an ambulatory environment, the child may require to be transferred to a facility for lab and radio evaluations as well as proper follow-up care. According to Jack, et al., (2017), even though a child is moved to some other doctor or institution, the doctor or nurse who was initially involved in the child’s treatment is still supposed to report. It is also the job of the practitioner to notice possible abuse rather than to determine the culprit (Berkowitz, 2017). The doctor can keep advocating for the kid, guaranteeing that he or she obtains the necessary follow-up care.

The legislation requires physicians to report incidents that might suggest infant or childhood abuse. Notwithstanding this mandate, care providers continued to underestimate violent assault (Marine & Forbes-Amrhein, 2021).   Bruises have been found as the most prevalent non-reported suspected event (Gilgoff, et al., 2020). Inability to disclose may be attributed to a refusal to detect abusive wounds in certain circumstances; however, underrepresentation may also happen if doctors and nurses believe that voicing their issues will harm patient empathy and a long-standing connection with parents (Jack, et al., 2017). Highlighting to caregivers that bruises are an ailment that requires hospital treatment and focusing on the child’s wellbeing instead of the caretakers as possible perpetrators may help speed up the procedure (Anda, et al., 2020).

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Nursing professionals play an essential role in mandatory reporting. It is required by law that all medical staff who work in emergency departments and in wards should be aware of the likelihood of child abuse and should be prepared to act accordingly, if abuse is suspected. Nursing professionals are considered to be ‘mandated reporters’ and they are required to notify the Child Protection after they form beliefs on the basis of reasonable judgment that the child may be sexually or physically abused in any manner. This is an obligation of the nursing professionals. Therefore, upon suspecting potential abuse in the case of Jack by noting the presence of a fracture right femur, injuries, and bruises at various sites, it is the responsibility of the nurse to mandatorily report this incidence to Child Protection, which can look further into the matter and take necessary measures (Victorian Forensic Paediatric Medical Service, 2022).

Adverse experiences in childhood could have a long-term influence on a child’s maturation and quality of life (Boullier & Blair, 2018). A number of abnormalities in the physical, psychological and developmental consequences have been related to childhood abuse (Anda, et al., 2020). The influence of child abuse on physical and mental health has been demonstrated in research studies. Infants who are subjected to psychological, physical, or developmental abuse, as well as other adversities, are more likely to have poor self-rated wellbeing, chronic illnesses, functioning limits, eventual death, and poor psychological health as adults (Berkowitz, 2017).

Adverse experiences in childhood have been linked to negative physical well-being (Anda, et al., 2020). This is significant since most of the prior studies on the link between ACEs and quality health outcomes either minimize or totally ignore the influence of adult socio-economic outcomes. Kids who are raised in hazardous and unpleasant circumstances are more likely to oppose socio-economic success-related social standards or have diminished aspirations or objectives (Rasmussen, et al., 2020).

Child Abuse And Physical Abuse Assessments: Evidence-Based Practices

Also, after accounting for all factors, early-life victimization which plays a major role in psychological consequences remained a strong and reliable forecaster of self-reported growth and physiological barriers.   Individuals’ judgments of their own wellbeing may be more lasting as a result of childhood verbal harassment. Future study should look into the processes that relate early age verbal and physical abuse to grownup health assessments in order to develop strategies to decrease the long-term impact of childhood abuse (Berkowitz, 2017).

Early life is a crucial time in one’s life since it shapes subsequent future education and areas of research. To the degree that ACEs are linked to degraded adulthood medical outcomes, these must be regarded as social determinants in healthcare across the life cycle and a cause of concern. According to Gonzalez, et al., (2021), early treatments with insecure or neglectful relationships among the family members may be one of the numerous options to reduce future inequalities and inequalities in health, considering that adverse experiences in childhood may subject infants and children to unfavorable socioeconomic life-course pathways (Boullier & Blair, 2018). Adult treatments that address the childhood development causes of adulthood inequalities may be more successful than adult programs that try to change health habits or increase access to quality healthcare (Narang, et al., 2020).

Psychological discomfort, like some other cognitive illness issues, has been linked to a variety of elements at various social-ecological systems, according to research. The majority of mental problems occur during the dynamic time of development, which is between the ages of 12 and 24 (Rasmussen, et al., 2020). There is a correlation between poor or emotional experiences in infancy and the emergence of negative health consequences such as psychological and physical health issues later, as per research (McKelvey, et al., 2018).

Adverse childhood experiences have been proven in past studies to have a deleterious influence on child growth, with long-term implications (Gilgoff, et al., 2020). Aggravation or initiation of many illnesses and risk behaviors are only a few of the outcomes. Smoking reliance, self-harm behavior patterns, victimization of aggressive behavior towards the spouse and other family members, numerous sexual affiliates, abortion on demand, anxiousness, depressive feelings, hyperlipidemia, joint problems, high blood pressure, hyperglycemia, and cerebrovascular disease are all more common in people who have had adverse outcomes. The results of various relationships are examined and reported (Rasmussen, et al., 2020).

The ACEs study demonstrates the link between childhood trauma and bad life consequences later on in life (Gilgoff, et al., 2020). Stress response illustrates how ACEs cause cellular response that result in those consequences. ACEs activate all of this interconnected stress responsiveness. When a kid has repeated ACEs over years, particularly if there are no supporting adult connections to give cushioning defense, the events can provoke an inappropriate and long-lasting stress reaction that can cause physical fatigue (Rasmussen, et al., 2020).

Individuals who have been through a lot of adversity are not permanently ruined. There is a range of viable solutions to ACEs and its possible cycle of physiological damage that might aid a person’s recovery from neurotoxic stress-induced trauma. Therapy-induced treatments, which range from in-patient rehabilitation to frequent meetings with a psychotherapist, are at the most rigorous end of the scale and are developed expressly to cope with acute trauma (Narang, et al., 2020).

Mandatory Reporting By Nursing Professionals

Trauma-informed treatment or practice is much less strenuous, and though it does have an impact on how professionals in a variety of fields, including human services, pharmaceutics, and schooling, collaborate with people who were exposed to stressful events (Narang, et al., 2020). It needs to reflect a consciousness of the damage that took place and tends to take that all into consideration. From meditation techniques to intense fitness and peer assistance, there are various less-intensive practices that can assist people to decrease the impacts of stress (Levey, et al., 2017).

Individuals are provided an ACE calculation based on a quick check of their own family’s background of ACEs in a relatively prevalent practise called ACEs-based testing and recommendation. It can imply a broad, non-specific impression of heightened danger based on demographic probability, however, it can correctly forecast how a person would perform (Gilgoff, et al., 2020).

The optimal method to ACEs is to reduce the stressors in people’s life, if they are basic requirements like food, shelter, and clothes, or even more ingrained forms of strain like drug addiction, psychiatric disorder, violent partnerships, neighborhood crime, prejudice, or poverty. Fostering responsive connections with a parent or carer can also assist to buffer a kid from the effects of stress, and aiding adults & children develop crucial skills like organization, attention, and consciousness can enhance the persistence foundations. According to Levey, et al., (2017), the best strategy to avoid the long-term impacts of ACEs is to follow these three pillars: reduce stress, establish adaptive connections, and enhance life competencies (Rasmussen, et al., 2020).

ACEs are common in young people and are linked to psychiatric discomfort later in life. Additionally, ACEs and mental trauma are linked to parental influences (Narang, et al., 2020). As a result, implementing routine mental health screening programs in schools, communities, and facilities is critical for early diagnosis, management, and therapy of kids with developmental abuse and poor mental illness results (Berkowitz, 2017). Furthermore, frequent ACEs assessments in primary healthcare and post-secondary contexts should be included in teenage and younger generation preventative care. Families should be educated about the immediate or long negative physiological effects of ACEs on people, as well as ACE prevention methods at home (Coore Desai, et al. 2017).

Conclusion:

The influence of child abuse on physical and mental health has been demonstrated in research studies. Although bruising is the prevalent indication of child physiological abuse, nurses might find it difficult to determine whether to be worried about exploitation as well as how to evaluate bruises in this setting. Child bruising is a frequent and generally harmless type of trauma that does not necessitate further study or treatment. Bruises have been found as the most prevalent non-reported suspected event. Adverse experiences in childhood could have a long-term influence on a child’s maturation and quality of life. A number of abnormalities in the physical, psychological and developmental consequences have been related to childhood abuse. The influence of child abuse on physical and mental health has been demonstrated in research studies.

References

Anda, R. F., Porter, L. E., & Brown, D. W. (2020). Inside the adverse childhood experience score: strengths, limitations, and misapplications. American Journal of Preventive Medicine, 59(2), 293-295. https://doi.org/10.1016/j.amepre.2020.01.009

Berkowitz, C. D. (2017). Physical abuse of children. New England Journal of Medicine, 376(17), 1659-1666. DOI: 10.1056/NEJMcp1701446

Boullier, M., & Blair, M. (2018). Adverse childhood experiences. Paediatrics and Child Health, 28(3), 132-137.

https://doi.org/10.1016/j.paed.2017.12.008

Carreiras, D., Cunha, M., & Castilho, P. (2021). Which self-compassion components mediate the relationship between adverse experiences in childhood and borderline features in adolescents? Self-compassion in adolescents. European Journal of Developmental Psychology, 1-22. https://doi.org/10.1080/17405629.2021.1981283

Coore Desai, C., Reece, J. A., & Shakespeare-Pellington, S. (2017). The prevention of violence in childhood through parenting programmes: a global review. Psychology, Health & Medicine, 22(sup1), 166-186. https://doi.org/10.1080/13548506.2016.1271952

Gilgoff, R., Singh, L., Koita, K., Gentile, B., & Marques, S. S. (2020). Adverse childhood experiences, outcomes, and interventions. Pediatric Clinics, 67(2), 259-273. https://doi.org/10.1016/j.pcl.2019.12.001

Gonzalez, D., Mirabal, A. B., & McCall, J. D. (2021). Child abuse and neglect. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459146/

Jack, S. M., Ford?Gilboe, M., Davidov, D., MacMillan, H. L., NFP IPV Research Team, O’Brien, R., … & McNaughton, D. (2017). Identification and assessment of intimate partner violence in nurse home visitation. Journal of clinical nursing, 26(15-16), 2215-2228. https://doi.org/10.1111/jocn.13392

Johnson, E. L., Jones, A. L., & Maguire, S. (2021). Bruising: the most common injury in physical child abuse. Paediatrics and Child Health, 31(11), 403-409. https://doi.org/10.1016/j.paed.2021.08.001 . Child Abuse And Physical Abuse Assessments Paper