The Importance Of Childhood Experiences

Childhood is an important phase of development in each person’s life. The experiences that an individual has during their childhood affect their whole life. Positive experiences during childhood build a person’s confidence and promote healthy development (Crouch et al., 2021). The absence of such experiences can be distressing for young children. Additionally, if the child experiences adverse childhood experiences, they may develop challenging behavior and that can often lead to negative impact in their later life. Adverse childhood experiences can be any potential traumatic event that harms the child physically or mentally before they turn 18 (Gilgoff et al., 2020).

Injuries in childhood are very common and are not generally a result of abuse. As children get injuries almost every other day, most of these injuries do not require medical attention. However, these injuries are usually minor and do not have any serious outcomes. In the present case, Jack is a 3-months old baby boy who is accompanied by his mother to the hospital and presents with a fracture in his right femur. On assessment, it was found that the fracture site had bruises and a discernable swelling. Apart from that, there were bruises around his ankle and left ear. On questioning his mother about the bruises she answers vaguely, which may indicate lying.  Because injuries are so common identification of physical abuse in infants is extremely difficult because there are no witnesses other than the perpetrator and the child. The child is usually too scared to respond or as in the present case, does not know how to talk. Also, the perpetrator will not accept his fault in relation to the injury. Thus, proper management of minor but suspicious injuries can protect vulnerable children through proper recognition and interventions.

Jack is possibly suffering from physical abuse which can be deduced from his fracture and multiple bruises. Physical abuse involves beating, kicking, biting, scarring, and burning. Fractures are a very common type of injury that indicate physical abuse in children, particularly in babies. As Jack is just 3-months old and is non-ambulatory, it is highly possible that his fracture is because of abuse (Marine & Forbes-Amrhein, 2021). It can be attributed to neglect on the part of his parents. Bruises are common in children and are therefore not usually considered physical abuse. However, bruises in babies as young as Jack are quite suspicious. The bruises at the fracture site can be considered a genuine accident but the other bruises seem suspicious. Thus, the presence of bruises at multiple sites and femur-fracture make it evident that Jack suffered from physical abuse.  Physical Abuse And Adverse Childhood Experiences Discussion Paper

As a nurse, it is important to provide proper attention to all patients and thus a thorough physical assessment has to be performed. As mentioned bruising in non-ambulatory children are a cause of concern (Igwe & Igwebuike, 2017). To remember the locations of bruising that are a cause of concern, a mnemonic of “TEN 4” can be used. It highlights the locations which are: torso, ear, neck, and 4 implies any bruising in babies younger than 4-months old. According to Martinkevich et al. (2020), 80% of all fractures in non-ambulatory children are caused due to physical abuse, particularly in children less than 18-months old. Some fractures are more indicative of abuse than others. Corner or bucket handle fractures (fractures affecting long bones like tibia or femur), posterior or lateral rib fractures, spinal, sternal, and scapular fractures are more suggestive of abuse (Gonzalez, Mirabal & McCall, 2021). When physical abuse is suspected the first step is the stabilization of the child. It can be achieved by monitoring breathing and checking the respiratory and circulatory systems. The suspicion of child abuse must be reported and the involvement of a child maltreatment specialist will be ideal to handle the situation.

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Identifying Physical Abuse In Non-Ambulatory Children

All medical staff is expected by law to be aware of and prepared for the plan of action in case of suspected physical abuse. Nurses are regarded as “mandated reporters” who are required to inform Child Protection if they suspect abuse of any kind that is formed on the basis of their sound judgment. All nurses are obliged to follow this protocol. Hence, on suspicion of physical abuse in Jack’s case because of the fracture in the right femur and observed bruises at different sites, it is the nurse’s responsibility to inform Child Protection regarding the same (Victorian Forensic Pediatric Medical Service, 2022). They will then decide the future course of action to protect the vulnerable patient.

Childhood experiences have a long-term effect on the well-being of an individual and the role of the family is crucial in that. Maximum adverse experiences during childhood are due to the involvement of parents or any close family member. Adverse experiences may hamper the child’s overall development, be it physical, psychological or developmental. According to Boullier & Blair (2018), children who experience adverse experiences are at greater risk of developing chronic diseases like cancer and cardiovascular diseases. Children, who suffer from abuse, are more prone to having poor psychological development and physical well-being during adulthood. It is also observed in studies that with an increase in the number of ACE experiences, the negative impact on health is also enhanced (Austin, 2018). Children who suffer from maltreatment at a young age are three times more susceptible to developing an external or internal disorder (Zeanah & Humphreys, 2018). When a child faces these experiences over numerous years without any comfort or support from an adult to protect them from such experiences, they evoke inappropriate and long-term stress that eventually causes physical, mental and social problems throughout life.

Stressors have been shown to impact the immunological functioning of suffering persons. One long-term physical impact of adverse childhood experience is the disruption in neurological and immunological functioning of an affected person because of chronic arousal of the body’s physiological response to stress, negative health practices, depression, and PTSD all of which cause health disparities throughout life. According to Sonu, Post & Feinglass (2019), adverse experiences during childhood enhances the chances of acquiring multiple chronic diseases. Trauma causes changes in parts of the brain that are responsible for the regulation of intense emotions thereby deactivating them. Hence, multiple exposures to stressors can increase emotional reactions and decrease emotional control (Dye, 2018). Thus, trauma disrupts multiple brain functioning thereby disrupting sleep, appetite, mood, emotions, language and reasoning. It may also create an imbalance between biological and developmental age. Our bodies can adapt according to and for our environments so as to better deal with the stress present in the environment. When we undergo a stressful experience our body responds to it by increasing heart rate and dilating pupils. It also activates the hypothalamic-pituitary-adrenal axis which increases glucose production for immediate use as our body prepares for flight or fight response (Boullier & Blair, 2018). However, overexposure to such situations is not helpful, especially at a young age. If a parent or caregiver is not there to provide support and deal with such a situation the child fails to recover from the stress and hence develops neurological, immunological and endocrine problems.

Prevalence Of Physical Abuse In Children

The psychological impact of adverse experiences on a person is also significant. It increases the chances of the child suffering from ACE of having depression, anxiety, personality and behavioral issues, which may provoke suicide in them. They can also hamper the decision-making abilities of an individual thereby creating complications in education, employment, housing stability and social support in later life (Mosley-Johnson et al., 2019). Thus, adverse experiences impact not only physical health but also psychological health of the affected person. Further research should be performed in order to figure out methods to reduce the long-term impacts of abuse or neglect in children. It has been found that early childhood trauma can impact psychological health more than trauma experienced in later life (Dye, 2018).

Childhood is an important phase in the development of a person hence, adverse events that occur during childhood create a lasting impression. They have the potential to influence developmental pathways thereby shaping the character and content of adult life. The relationship of a child with their mother is extremely crucial as it develops subsequent relationships. While a healthy attachment increases healthy relationship probability in the future, poor relationships cause behavioral problems in life. The harm can be on the development of social, emotional, cognitive and academic skills (McKelvey et al., 2018). They often cause disturbed peer relationships in such individuals which can cause increased aggression, inappropriate outbursts and poor social skills. This poor development in skills often leads to disappointment in the future life be it in education or work. Another impact of adverse experiences in children is the development of risky and challenging behavior in young adults like smoking, drinking, gambling, and self-harm. As they grow older, they themselves start practicing abuse as they start considering these behaviors normal. They then practice abuse against partners, other family members, own kids or even peers. They may also victimize their aggressive behavior towards different people and seek sympathy for their mistakes.

Children who suffer from adverse childhood experiences can reduce their long-term impact by removing stressors from their life. Developing protective and understanding relationships between the victim and parent or any other caregiver can comfort them and they become capable of developing important life skills (Lipscomb et al., 2019). Research has shown that children who have positive experiences, even if they suffer adverse effects can handle life problems better. Positive childhood experiences like that of parental warmth and responsiveness enable a child suffering from adverse experiences better as they can confess and share their problems with them and find solace and comfort through their support (Bethell et al., 2019). From the works of Rasmussen et al. (2020), to avoid any long-term impact of adverse experiences, a person should avoid and remove possible stress-causing factors, develop adaptive relations and connections and improve life competencies.

Those who have suffered a lot of adversity are not completely devastated. As the burden of adverse experiences in childhood is huge on the future life of individuals, interventions must be taken to prevent them. The two most important steps include early recognition of abuse and primary prevention of adverse events (Boullier & Blair, 2018). Identification of abuse or neglect on time can be achieved by regular mental health screening programs that should be implemented at schools and facilities for better management of abuse or poor mental health as a result of abuse. To provide primary prevention primary sources must be targeted. Families and caregivers should also be educated about the negative impacts of ACE so that they are more careful while handling children (Lipscomb et al., 2019). As already stated parents and caregivers play the most important role in the life of a young child and their behavior and attitude towards the child and in general create a huge impact on the child’s mind. Thus, educating them will ensure that they can improve their behavior towards the child and help him to face problems instead of creating stressful situations for them. They should also be taught about methods to reduce and prevent adverse events. Moreover, healthcare centers should have physical assessments for adolescents and younger people so as to minimize adverse experiences. When proper care and protection will be provided to children they will develop coping mechanisms and face the stress better. Such early interventions will also ensure that children adapt and learn about healthy behaviors. If these interventions are implemented rigorously, cases of adverse childhood experiences can be reduced.

The Role Of Nurses In Identifying And Reporting Suspected Cases Of Physical Abuse

Conclusion

From the above discussions, it can be concluded that adverse experiences during childhood can impact the whole life of the affected individual. It can create problems in the physical, mental, emotional and even developmental well-being of that person. Thus, it is important that they are identified on time and steps to manage and reduce those experiences are taken. As a nurse, it is important to report any case that may have suspicions of any form of abuse on a child. As young children, like Jack, cannot speak about their injuries it is essential for a nurse to use her judgment and analyze such cases to identify potential abuse.

References

Austin, A. (2018). Association of adverse childhood experiences with life course health and development. North Carolina Medical Journal, 79(2), 99-103. https://doi.org/10.18043/ncm.79.2.99

Bethell, C., Jones, J., Gombojav, N., Linkenbach, J., & Sege, R. (2019). Positive childhood experiences and adult mental and relational health in a statewide sample: Associations across adverse childhood experiences levels. JAMA pediatrics, 173(11), e193007-e193007. 10.1001/jamapediatrics.2019.3007

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

Crouch, E., Radcliff, E., Merrell, M. A., Hung, P., & Bennett, K. J. (2021). Positive Childhood Experiences Promote School Success. Maternal and child health journal, 25(10), 1646-1654.  https://doi.org/10.1007/s10995-021-03206-3

Dye, H. (2018). The impact and long-term effects of childhood trauma. Journal of Human Behavior in the Social Environment, 28(3), 381-392. https://doi.org/10.1080/10911359.2018.1435328

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/

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

Igwe, W. C., & Igwebuike, V. O. (2017). Bruising in children: Evaluation in cases of suspected non-accidental injuries in children (physical child abuse). Nigerian journal of paediatrics, 44(1), 1-6. DOI: 10.4314/njp.v44i1.1

Lipscomb, S. T., Goka-Dubose, E., Hur, R. E. H., & Henry, A. (2019). Adverse childhood experiences, and instability in Children’s care and Parents’ work. Children and Youth Services Review, 102, 243-250.https://doi.org/10.1016/j.childyouth.2019.05.008

Marine, M. B., & Forbes-Amrhein, M. M. (2021). Fractures of child abuse. Pediatric radiology, 51(6), 1003-1013. https://doi.org/10.1007/s00247-020-04945-1

Martinkevich, P., Larsen, L. L., Græsholt-Knudsen, T., Hesthaven, G., Hellfritzsch, M. B., Petersen, K. K., … & Rölfing, J. D. (2020). Physical child abuse demands increased awareness during health and socioeconomic crises like COVID-19: a review and education material. Acta orthopaedica, 91(5), 527-533. https://doi.org/10.1080/17453674.2020.1782012

McKelvey, L. M., Edge, N. C., Mesman, G. R., Whiteside-Mansell, L., & Bradley, R. H. (2018). Adverse experiences in infancy and toddlerhood: Relations to adaptive behavior and academic status in middle childhood.  Physical Abuse And Adverse Childhood Experiences Discussion Paper