The term child abuse is used to describe any neglect or mistreatment of infants or children including infliction of emotional pain, physical injury, or sexual exploitation. Neglect or abuse is most often inflicted by the child’s biological parents. Others who have been implicated include foster parents, babysitters, boyfriends, friends, and daycare workers. Nurses are legally and morally responsible to identify children who may be maltreated and to report findings to protect the child from further abuse.
Neglect is the most common form of abuse and may include deprivation of basic physical or emotional needs: food, clothing, shelter, healthcare, education, affection, love, and nurturing. Emotional abuse stems from rejection, isolation, and/or terrorizing the child.
Physical abuse may result in burns, bruises, fractures, lacerations, or poisoning. Infants may suffer from “shaken baby syndrome” with severe or fatal neurologic injuries caused
by violent shaking of the infant. Signs of shaken baby syndrome include retinal and subarachnoid hemorrhage. Signs of sexual abuse include bruising or bleeding of the anus or genitals, genital discharge, odor, severe itching or pain, and sexually transmitted diseases. A discrepancy between the nature of the child’s injuries and the reported cause of injury is a frequent clue that abuse has occurred.
Nursing Care Plans
The major nursing care planning goals for the child experiencing abuse includes ensuring adequate nutrition, safety of the abused child, relief from anxiety, improving parenting skills and building parental confidence.
Here are four (4) nursing care plans (NCP) and nursing diagnosis (NDx) for child abuse:
Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis
- Imbalanced Nutrition: Less Than Body Requirements
May be related to
- Inability to ingest food
- Parental neglect on nutritional status
Possibly evidenced by
- Loss of subcutaneous fat
- Inadequate amount of food
- Weight loss
- Malnutrition
- Withholding of food by parent/caretaker
- Failure to thrive
Desired Outcomes
- Child will manifest no further weight loss and, if malnourished, will gain 2.2 lb (1 kg)
per week.
| Nursing Interventions | Rationale |
|---|---|
| Assess for signs and symptoms of malnutrition. | A child with nutritional deficiency manifest decreased attention span, confused, pale and dry skin, subcutaneous tissue loss, dull and brittle hair, and red, swollen tongue and mucous membranes. |
| Monitor intake and output and food intake; Weigh client daily. | Allows the evaluation of the number of calories being consumed per day and progress of nutritional therapy. |
| Assess and record the amount, consistency, and color of stools and emesis. | Provide a guide on the absorption of nutrients in the body. |
| Maintain good oral hygiene prior meals. | Promotes good appetite and enhances the taste of foods/fluids. |
| Encourage parents to assist the child during feeding. | Eating as a self-care activity enhances self-esteem. |
| Encourage small, frequent feedings high in carbohydrates and protein. | Small meals decrease fatigue and are easier to tolerate. |
| Encourage adequate rest periods. | Minimizes fatigue and improve the child’s appetite. |
| Consider the possible need for enteral or parenteral nutritional support as indicated. | Nutritional support may be recommended for those who are unable to maintain nutritional intake by the oral route. |
| Consult and refer to a dietitian or nutritional support team for dietary counseling. | A dietitian or nutritional support team can individualize the child’s diet within prescribed restrictions |
