Name : Mrs.

Sayma Mansuri

Subject : Child Health Nursing

Topic : Child Abuse

Date : 25/03/19

Time : 11:00 AM

Venue : Nootan College of Nursing ( 3rd year B.sc(N) classroom)

Method of teaching : Lecture cum discussion

A.V aids : Power point

Evaluator Name : Mrs, Mahalakshmi.B

General objective:
After completion of this teaching practice students will be able to understand about child abuse.

Specific objectives:
After completion of this teaching practice students will be able to:
 Introduce about the child abuse.
 List out the types of neglect.
 Enumerate the sign and symptoms of child abuse.
 Explain the clinical manifestation of physical abuse.
 List out the assessment for child abuse.
 Detail about the treatment of child abuse
 Discuss the nursing role of child abuse.
 Explain the prevention child abuse.
 TIME SPECIFIC CONTENT TEACHING A. V. AIDS EVALUTION
OBJECTIVE LEARNING
ACTIVITY
 CHILD ABSUE
 INTRODUCTION –
1 min To introduce about Lecture cum Power point Whai is introduce
the child abuse discussion about the child
Child neglect is the most common form of abuse?
maltreatment. Neglect is generally defined as the
failure of a parent or other person legally
responsible for the child’s welfare to provide for the
child’s basic needs and an adequate level of care.

Which type of
1min Enlist about the  TYPE OF NEGLECT – neglect?
types of neglect
 PHYSICAL NEGLECT – involves the deprivation of
necessities such as food, clothing, shelter,
supervision, medical care & education.
 EMOTIONAL NEGLECT – refers to failure to meet
the child’s needs for affection, attention and
emotional nurturance.
Lecture cum Power point What is
 PATHOPHYSIOLOGY discussion pathophysiology
0.5min Explain about the of child abuse?
pathophysiology of The pathophysiology is the result of injuries
child abuse
that may be due to beating, twisting the
extremities, punching, scalding or burning with
cigarettes.

List out the sign and  SINGS AND SYMPTOMS

0.5min symptoms of child What are the
abuse. sign and
  Sign and symptoms consist primarily of bruises, symptoms of
scratches, burns, hematomas and fractures of long child abuse?
bones, ribs or skull as well as discomfort and pain.

 Neglect, is the chronic failure of adults to protect

the child from obvious physical danger or to provide
the care needed.

1min To identifie the  ASSESSMENT Lecture cum Power point What are the
assessment of child  History Taking discussion Assessment of
abuse. child abuse?
 Physical Examination
 X – Ray- stages of healing of several bone
lesions.
 The different diagnosis depends on the
particular injuries.

3min Describe the  TREATMENT Lecture cum Power point What are the
treatment of child  Appropriate medical, surgical and discussion treatment of
abuse. psychiatric treatment should be promptly child abuse?
initiated.
 The law requires that a child suspected of
being abused or neglected be reported
immediately to child protective services
(CPS)
 Suspected abuse child should not be
discharged from the clinic or office without
consulting the country CPS.
 Hospitals caring for children should have a
team of professionals who are trained &
skilled in child abuse recognition, reporting
and services. This team should include a
 pediatrician, a hospital social worker, a
pediatric nurse, a psychologist or
psychiatrist and a data coordinator.
 Provide symptomatic treatment to the
child.
 Provide more intensive surveillance and
well child case for the abused and neglected
children.
 Abused children need good physical case
and love.
 Provide psychological support to the child
and parents.
 Provide the counseling to the parents
regarding to child rearing, positive parents
behaviors and involvement of parents in
child's care activity.

 PARENTS ANONYMOUS Lecture cum

 Self – help, non profit groups called parents discussion Power point
Anonymous have been organized across the
country.
 Ideally, each abusive individual should have
a normal adult who can assume the role of
parent.
 The main objective is to establish a positive
parent- child relationship and to restore the
parents self confidence by changing old
habits one step at a time. These self help
groups need the support and
encouragement of the nurses as a
professional or as a friend.
 THEORETICAL PERSPECTIVES ON CHILD
 ABUSE

 MENTAL ILLNESS MODEL – Lecture cum

This explanation for bike abuse states that discussion Power point
parents who abuse their children are mentally ill.
The goal is to cure the parent, who will them stop
the abuse. This model was developed very early in
the identification and treatment of abuse.

 ENVIRONMENTAL STRESS MODEL –

In this model, two factors interactt
precipitate abuse a violent environment and stress.
The violent environment can be found either in
society or the family. Abusive parents ideologically
belong to that segment of society that approves of
physical violence against children in certain
circumstances. According to this theory, the
violence has to be a result of child behavior abuse
for no reason is unacceptable. This model is used to
explain intergenerational abuse those abuse as
children were exposed to an environment that
tolerated and even sanctioned child abuse as a
method of problem solving.

 SOCIAL LEARNING MODEL –

This model to explain how humans learn
behavior was developed by Bandura (1973). Many Lecture cum
discussion Power point
human behaviors are learned through observation
as well as through behavioral reinforcement. This
model of abuse is useful because it includes cultural
and family influences.

 SOCIAL PSYCHOLOGIC MODEL –

  This model was proposed by Kempe and
Helfer (1972). For abuse to occur, three
variables must be present;
 A special parent,
 A special child and stress.
 The parent can be “special” in a number of
ways, including being immature having
unrealistic expectations of the child, having
poor impulse control and failing to recognize
and respect the child ah a unique individual.
 The child can also be special in several ways;
“wrong” sex, physically or mentally disabled,
“different” from the other children in the
family of tem chronic.
 This is important because of the frequent
difference of perception of stress between
the two groups and the professional's
limited understanding of the parent's
lifestyle and resources.
Lecture cum
 HUMAN ECOLOGIC MODEL – discussion Power point
This model to explain child abuse was
developed by Garbarino (1977). It says that abuse is
a result of interactions of the culture, the family,
the parent, the bike and stress. It identify the family
ah the dysfunctional system, with abuse being a
symptoms. This suggests that parents the abused
child and other children in the family interact in
What is cycle of
such a way that abused occur occurs during periods child abuse?
of stress.

 PSYCHOLOGIC - SOCIOLOGIC MODEL FOR

1min SEXUAL ABUSE –
 Finkelhor (1984) has presented a model
specification related to sexual abuse. It has 4
components, developed from an individual
and a socio cultural level. What is physical
 First, the perpetrator must be motivated to abuse?
abuse a child sexually.
 Second, necessary for sexual abuse to occur
is the overcoming of internal inhibitors.
 Third, external inhibitors must be overcome
Mother's ability to protect her children.
 Finally, the resistance of the child must be
overcome. Children can play a role in
whether they are sexually abuse.

 CYCLE OF CHILD ABUSE Lecture cum

1min Describe the cycle of discussion Power point
Many parents who abuse their children
child abuse.
were themselves victims of child abuse because
they unable to meet their parents needs. These
individuals, lacking love and security as children,
become lonely adults who, when they are of an age
to marry, seek a loving parent figure to care for
them.

 PHYSICAL ABUSE
5min Detail about the
physical abuse  The deliberate infliction of injuries on a Lecture cum
child, usually by the child's caregiver is discussion Power point
termed physical abuse. Minor physical injury
is responsible for more reported cases of a
treatment than major.
 FACTORS PREDISPOSING TO PHYSICAL
ABUSE
  The exact cause of abuse is not known but
three major criteria
 Parental characteristics.
 Characteristics of child.
 Environmental characteristics.
Parental Characteristic-
 Violence,
 Poverty,
 Parental history of abuse,
 Socially isolated,
 Low self esteem, What are the
 Less adequate maternal functioning. clinical
Characteristic of Child – manifestation of
 No. of children’s, physical abuse?
 Child's temperament,
 Position in the family,
 Additional physical needs if ill or disabled,
 Activity level or degree of sensitivity to parental
needs.
 Occasionally the abused child is ill e.g. it is mate,
unwanted, brain damaged, hyper active or
physically disabled.
Environmental Characteristics– Lecture cum
 Chronic stress, discussion Power point
 Problem of divorce,
 Poverty,
 Unemployment,
 Poor housing,
 Frequent relocation,
 Alcoholism,
 Drug addiction.
  CLINICAL MANIFESTATION – Lecture cum
1min discussion Power point
 PHYSICAL NEGLECT –
SUGGESTIVE PHYSICAL FINDINGS –
 Failure of Thrive,
 Signs of mal nutrition such as thin
extremities, abdominal distension,
 Poor personal hygiene,
 Unclean and in appropriate dress,
 Evidence of poor health case, such as
delayed immunization, untreated infections,
frequent colds,
 Frequent injuries from lack of supervision.
SUGGESTIVE BEHAVIORS-
 Dull and inactive; excessively passive or
sleep,
 Self - stimulatory behaviors, such ah
finger - sucking or rocking,
 Begging or stealing food,
 Absenteeism from school,
 Drug or alcohol addiction,
 Vandalism or shoplifting.

 PHYSICAL ABUSE –
Lecture cum
SUGGESTIVE PHYSICAL FINDINGS – discussion Power point
 Bruises and Welts -On faces, lips, mouth,
back, buttocks, thighs regular patterns
descriptive of object used such as belt
buckle, hand, wise hanger, chain, wooden
spoon, squeeze or pinch mark.
  Burns- on sole of feet, palms of hand, back
or buttocks. Patterns descriptive of object
used, such as sound cigar or cigarette burns,
 immersion in scalding water, rope burns on
wrists.
 Absence of ' splash' marks and presence of
symmetric burns.
 Stun gun injury: lesions circular, fairly
uniform (up to 0.5 cm).
 Fractures and dislocations-
Skull, nose or facial structures.
Multiple new or old fractures in What are the
various stages of healing. Nursing care of
 Lacerations and abrasions- physical abuse?
On back of arms torso, face or
external genitalia.
Descriptive marks such as from
human bites or pulling hair out.
 Chemical-
UN explained repeated poisoning,
especially drug overdose.

SUGGESTIVE BEHAVIOUR – Lecture cum Power point

 Wary of physical contact with adults. discussion
 Apparent fear of parents or going home.
 Lying very still while surveying environment.
 In appropriate reaction to injury, such as failure to
cry from pain.
 Withdrawal behavior.
 Superficial relationship.
 Lack of reaction to frightening events.
2min Classify the nursing  NURSING CARE OF PHYSICALLY ABUSED Lecture cum Power point
care of physically discussion
abused children.
CHILDREN

CHILD AND FAMILY ASSESSMENT –

 Use age - appropriate methods to assess
development; preverbal and young children
respond to play therapy with folks that
represent family members.
 Provide age - appropriate support for the
child during radio logic and other diagnostic
tests. - Document physical injuries.
 Document observations of child behavior
that indicate psychologic and emotional
status.
 With other health care team members,
complete the family assessment.
PLANNING AND INITIATING CARE –
 Assess level of knowledge and skill of parent
regarding childcare and development.
 Identify one nurse as the child's primary care giver.
 Develop a clearly defined plan of case to be
followed by all nurses.
What are the
 Involve older children in developing the plan for
prevention of
their own care.
Physical abuse?
 Plan patient care to include parental participation.

INTER DISCIPLINARY PARTICIPATION IN CARE – Lecture cum Power point

 Provide positive reinforcement for family / parent discussion
strengths.
 Model healthy communication and parenting
behavior.
 Inform parents that child protection services are
 being notified. Without judging or accusing parents.
 Explain that the objective of involvement is to
strengthen family functioning and prevent future
harm to children.
 Support parents during initial interviews with child
protection workers.
 Assist parents in identifying strategies necessary to
prevent future always.

2min Describe the

 PREVENTION FROM PHYSICAL ABUSE Lecture cum Power point
prevention from discussion
physical abuse.  The pediatrician's role in primary abuse
prevention includes identifying parents at
high risk for being unable to accept, love
and properly discipline and care for their
offspring.
 The history obtained from all parents should
include information about pregnancy
planning, pregnancy, emotional and physical
health, domestic violence and attitudes
about the child and child- rearing
experiences.
 Abuse and serious neglect may be
prevented when at- risk families receive
intensive training and support during
pregnancy and after delivery.

 PROGNOSIS –
Early studies of abused children returned to
their parents without any intervention indicate that
about 5 are subsequently killed and that 2 5 are
 seriously re- injured with comprehensive, intensive
family treatment, 8- 9 of families involved in child
mal treatment may be rehabilitated to provide
adequate care for their children.

 EMOTIONAL ABUSE AND NEGLECT

SUGGESTIVE PHYSICAL FINDINGS – Lecture cum
 Failure to thrive. discussion Power point
 Feeding disorders, such as rumination
 Enuresis
SUGGESTIVE BEHAVIORS –
What is the
 Self-stimulatory behavior such as biting, rocking.
sexual abuse?
 During infancy, lack of social smile and stranger
anxiety.
 Withdrawal
 Unusual fearful ness
 Antisocial behavior, such as destructiveness,
stealing, cruelty
 Lags in emotional and intellectual development,
especially language
 Suicide attempts.

SEXUAL ABUSE
Sexual abuse includes any activity with a child,
before the age of legal consent that is for the sexual
gratification of an adult or a significantly older child. Sexual
abuse includes oral - genital, genital - genital, genital - recta
l, hand - genital, hand - recta l or hand breast contact;
exposure of sexual anatomy, forced viewing of sexual
anatomy; and showing of pornography to a child or using a
child in the production of pornography.
 DEFINITIONS –
2min
 SEXUAL PLAY:–The other hand may be defined as Lecture cum Power point
viewing or touching of the genitals, buttocks or discussion
chest by pre adolescent children 4 separated by not
more than 4 years, in which these has been no
force or coercion.

 INCEST: –Any physical sexual activity between

family members; alone relationship is not required
causes can include step parents, upper siblings,
grand parents, aunts and uncles does not include
sexual relations between legally sanctioned parents
such as spouses. E.g. Brother-sister.

 MOLESTATION :–A vague term that includes

“indecent liberties”, such as touching, foundling,
kissing, single or mutual masturbations, or oral-
genital contact. What are the
etiology of
 EXHIBITIONISM: –Indecent exposure, usually physical abuse?
exposure of the genitals by an adult to children or
other adults.

 CHILD PORNOGRAPHY:–Arranging and

photographing in any media sexual acts involving
children, either alone or with adults or animals,
regardless of consent by the child's legal guardian;
also may denote distribution of such material in any
form with or with out profit.

 CHILD PROSTITUTION:–Involving children in sex

 acts for profit and usually with changing partners. What are the
clinical
 PEDOPHILIA:–Laterally means “Love of child” and manifestation of
does not denote a type of sexual activity but the sexual abuse?
preference for pre pubertal children as the means
of achieving sexual excitement.

 ETIOLOGY/ METHODS – Lecture cum Power point

1min discussion
 Gifts or privileges.
 Misrepresents moral standards by telling the
child that it is 'okay’
 Emotionally and socially impoverished
children
 Sex offender pressures the victim into
secrecy regarding the activity by describing
it as a secret between us.
 Child's fears
 Vulnerable children

1min  CLINICAL MANIFESTATONS

Lecture cum Power point
discussion
SUGGESTIVE PHYSICAL FINDINGS –
 Bruises bleeding, lacerations or irritation of
external genitalia, anus, mouth or throat
 Torn, stained or bloody under clothing
 Pain on urination or pain, swelling and
itching of genital area
 Penile discharge
 Sexually transmitted disease, non specific
vaginitis or venereal warts
 Difficulty in walking or sitting
  Pregnancy in young adolescent
 Recurrent urinary tract infection
What are the
SUGGESTIVE BEHAVIORS investigation of
Sexual abuse?
 Sudden emergence of sexually related
problems, including excessive or public
masturbation, age - in appropriate sexual
play, promiscuity or overtly seductive
behavior.
 With drawn, excessive day dreaming
 Poor relationships with peers
 Preoccupied with fantasies, especially in
play
 Regressive behavior, such as bed- wetting or
thumb – sucking
 Sudden onset of phobias or fears,
particularly fears of the dark, men, strangers
or particular settings or situations (e.g.
Undue fear of leaving the house).
 Running away from house - Substance abuse
- Rapidly declining school performance What are the
 Suicidal attempts or ideation. treatment of
sexual abuse?
 INVESTIGATION –
1min Lecture cum Power point
discussion
Investigating the possibility of sexual abuse requires
supportive sensitive and detailed history taking.
 History Taking
 Physical Examination
 Laboratory Findings- It depends on the
history and the time since injury.
 Specimens of offender blood, hair and the
 victim's mail clipping and clothing
 Gonorrhea and chlamydia cultures should
be obtained from the mouth, anus and
genitals.
 In the vagina, motile sperm can be found for
6 hr non motile sperm exist for longer than
72 hrs.

1min  TREATMENT –
Lecture cum Power point
discussion
 It is a criminal offense and is investigated by
the police
What are thre
 All victims of sexual abuse require nursing care of
psychological support. sexual abuse
 The consequences and appropriate therapy children?
of sexual abuse vary, depending on the type
of abuse; the age and other physical and
emotional factors in the victim.
 The therapist may recommend that the
victim of incest be returned home he the
perpetrator is out of the home.
 Medication to prevent pregnancy may be
given to post menarchal girls with in the
previous 72 hr intercourse.
 Treatment with antibiotics is initiated to
prevent sexually transmitted diseases.
 The offending parents and spouse should be
referred for psychiatric or psychologic
evaluation.
1min To provide the  NURSING CARE OF SEXUALLY ABUSED What are the
nursing care of Lecture cum Power point prevention of
sexually abused
CHILDREN discussion sexual abuse?
children.
 Nurse must be aware of the presenting
symptoms that frequently mask sexual
abuse (abdominal pain, somatic complaints
with no identifiable cause).
 Nurse must be able to support a patient /
after disclosure.
 The nurse who understands the
investigative assessment procedure will be
able to judge.
 Nurse suggestions about age – appropriate
ways to gather data can be valuable to the
interviewer.
 The nurse provides support to the patient
and family and to record accurately child
behavior and child – parent interactions.

 PREVENTION –
 The primary prevention of sexual abuse is
related, in part, to normal developmental Lecture cum Power point
education and sexual behavior. discussion
 Teaching children the proper names of all
body parts, including the names, function
and significance of ' private parts' nipples,
What arethe
genitals and rectum nursing role of
 Teach to children should be say 'NO'. child abuse?
 Victim therapy should decrease the
potential for re- abuse.
 Routine family discussions of uncomfortable
events.
  Written permission should be obtained from
any caregiver to allow a police screening for
offenses.

 PROGNOSIS –
With early and adequate intervention,
Lecture cum Power point
victims may lead normal adult lives. However, even discussion
with intervention, certain adolescent victims may
run away from home and fall to adolescent
prostitution, violence, drug addiction and
unprepared parenthood. Others who remain at
home may manifest a variety of emotional
problems, including depression, suicidal gestures,
deterioration in school performance and conversion
reactions.

Describe the nursing  NURSING ROLES IN PREVENTION OF CHILD

1min roles in prevention ABUSE Lecture cum Power point
of child abuse. discussion
The nursing role in prevention of child abuse What are the
nursing diagnosis
and maltreatment is addressed here by using 5
of child abuse?
objectives as a framework –
 Increase public awareness of the nature and
extent of efforts to prevent child abuse.
 Increase knowledge of health professionals.
 Coordinate and improve the availability,
accessibility and quality of health services to
families.

(A) Advocacy for expanded health and social

services for children and families.
(B) Identification and treatment of families
 at high risk for child abuse and
maltreatment.
 Develop data systems to monitor the
incidence and prevalence of all forms of
child abuse.
 Research.

 NURSING DIAGNOSIS –
1min Describe the nursing Lecture cum Power point
 Fear / anxiety related to negative
diagnosis in child discussion
interpersonal interaction, repeated
abuse
maltreatment, powerlessness, potential loss
of parents.
 Impaired parenting related to child,
caregiver or situational characteristics that
precipitate abusive behavior.
 Risk for trauma related to characteristics of
child, caregiver and environment.
 Deficient knowledge about the child’s
realistic developmental abilities how to
access external support resources related to
past inexperience with parenting.

OTHER NSG DIAGNOSIS –

 Pain related to inflicted injury.
 Impaired skin integrity relate to inflicted
injuries.
 Altered nutrition less than body
requirements related to inadequate caloric
intake.

 NURSING DIAGNOSIS –
Lecture cum Power point
  Fear / anxiety related to negative discussion
interpersonal interaction, repeated
maltreatment, powerlessness, potential loss
of parents.
 Impaired parenting related to child,
caregiver or situational characteristics that
precipitate abusive behavior.
 Risk for trauma related to characteristics of
child, caregiver and environment.
 Deficient knowledge about the child’s
realistic developmental abilities how to
access external support resources related to
past inexperience with parenting.
OTHER NSG DIAGNOSIS –
 Pain related to inflicted injury.
 Impaired skin integrity relate to inflicted
injuries.
 Altered nutrition less than body
requirements related to inadequate caloric
intake.
BIBLIOGRAPHY:

1. Wong’s, Marilyn J. Hockenberry, David Wilson, “Essentials of pediatric

nursing”, 8th edition, published by Elsevier.

2. Marlow R. Dorothy, Barbara A. Redding, Textbook of pediatric nursing,

6th edition, published by Elsevier.

3. Ghai. O.P., Piyush Gupta, V. K.Patil, Essential paediatrics, 6th edition,

published by CBS publishers, New Delhi.