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By Geneva Slupski
March 9, 2009 / Nurse.com
Rita Doval, RN, sadly recalls the laceration on the face of an infant she saw on Halloween at a Miami hospital. The nearly 5-month-old boy accidently became caught in the crossfire of an argument between his parents involving a knife.
Amid the stress and pressure of a tough economy, the risk of child abuse is increasing, warn child advocacy experts. They want nurses and other professionals who come in contact with children regularly to be on heightened alert for child abuse and neglect.
"In general, any kind of stressor does contribute," says Doval, nurse liaison for the University of Miami Child Protection Team. "If you take a family who's already under financial stress and then you add the turmoil with the economy now, I think you push them over the edge."
In the past few months, Doval's team, which includes doctors, social workers, and psychologists, has seen more children with severe head traumas and multiple fractures. They've also seen, as in the case of the infant on Halloween, a rise in injuries caused during fights between parents.
More than 3 million cases of child abuse are reported to authorities annually in the U.S., according to Childhelp, a national child abuse prevention organization in Scottsdale, Ariz. An estimated four children a day die from abuse, according to the agency, which also runs a national child abuse hotline.
Childhelp receives about 200,000 calls annually on the hotline, says executive director John Reid. By the end of 2008, that number had increased by about 10%.
"Healthcare professionals can really be one of the most important links in our ongoing battle against child abuse," Reid says. "They have the professional training. They have access to children in their day-to-day work."
An economic downturn is never an excuse to harm a child, Reid says, but it is a factor in a perfect storm for such actions. The agony of unemployment, foreclosure, or simply struggling to buy groceries can cause poor choices such as substance abuse, which can then lead to child abuse.
"You have parents finding it increasingly difficult to put food on the table," Reid says. "All of these are fertile breeding grounds that lead to the abuse and neglect of children. For example, if Dad is suddenly out of work and having a hard time putting food on the table, Dad may turn to risky behavior such as drinking too much."
Constant talk of a bad economy at home and school also might have some children acting out more than usual, says Susan Sherman, ARNP, CPNP. "When you look at the economy as it's going right now, people are kind of in a panic mode and everybody's worried," says Sherman, who works for Children's Advocacy Center of Southwest Florida in Fort Myers. "Children internalize and it may come out in their behavior. I'm not saying the children misbehave and their parents abuse them, I'm just saying it's one more piece of the puzzle that we have to look at as a risk factor. "
Under state law, Florida nurses are among professionals mandated to report suspected child abuse, says Cindy Kuharek, ARNP. Injuries nurses are required to report include head trauma, head or neck bruises, and fractures.
Nurses must pay attention to the history provided when collecting information and watch for inconsistencies, says Kuharek, who works for Help A Child in Pinellas Park, Fla.
For example, multiple marks on a youngster's face that a parent claims are from a rash could actually be "petechial" or high impact bruising. "It's not a rash, he's got a slap mark on his face," Kuharek says. "Nurses know how to tell the difference."
Another detail to consider is the age of the child, Kuharek says. Is the little one developmentally capable of injuring himself or herself in such a way? "Any bruise on a baby is suspect," Kuharek says. "If you see an injury and it's not making sense, then be aware. You may need a more detailed history."
Nurses also should remain open minded and careful not to jump to conclusions when dealing with suspected abuse, Doval says.
"The tone you set with a family early on is very important," she says. "You don't want to use a judgmental or derogatory tone with them. I believe that you treat any and every parent with respect and dignity and you interview them just like you would normal, non-abusive parents."
But abuse doesn't always involve physically hitting or inflicting other types of harm on a child. The current economic conditions also are right for neglect, which can include leaving children improperly clothed, dirty, or hungry, Kuharek says. Neglect is the most common type of abuse, she says.
The silver lining to these gathering storm clouds might be the measures underway in Florida to be proactive when it comes to child abuse and neglect. Child protection teams such as the one Doval works for are in place throughout the state. In addition to conducting assessments and providing court testimony, Doval does community awareness in the Miami area.
In July, the Children's Services Council of Palm Beach County (Fla.) was instrumental in bringing the Nurse-Family Partnership program to Florida. With services in place throughout the country, Denver-based Nurse-Family Partnership works with low-income, first-time parents to improve the health and well-being of children and families. Nurses visit first-time moms in their homes during and after their pregnancies, says Terri Kanter, RN, BS. Kanter is a senior community health nursing supervisor for the Palm Beach County Health Department.
"Home visits from nurses are an important part because you see [parents] in their home situations," says Kanter, who supervises the county's Nurse-Family Partnership nursing team. "There is a lot of opportunity to impact that person's life. The relationship that nurse develops with a client serves as a model for that client and her child."
The goal at Children's Advocacy Center of Southwest Florida is to keep parents and children together as much as possible, Sherman says. The center tries to refer parents to whichever social service they need, whether it's finding food, clothing, or job placement. Services such as in-home counseling and parenting classes provided through the Florida Department of Children and Families also help keep families together.
"I've been doing this job for eight years, and some weeks it's easier and some weeks it's harder," Sherman says. "We like to say around here, 'It's all about the kids.'"