West Visayas State University

COLLEGE OF NURSING

La Paz, Iloilo City

HEALTH PROBLEMS of
EARLY CHILDHOOD
Child Maltreatment

I. DEFINITION AND CLASSIFICATIONS

CHILD MALTREATMENT

The broad term child maltreatment includes intentional physical abuse or neglect, emotional
abuse or neglect, and sexual abuse of children, usually by adults. (U.S. Department of
Health and Human Services)

Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by
a parent, caregiver, or another person in a custodial role. (Centers for Disease Control and
Prevention)

It is any act which inflicts physical or psychological injury, cruelty to or the neglect, sexual
abuse of, or which exploits, a child. (Department of Justice, Philippines)

 Types of Maltreatment
1. physical abuse
2. child neglect
3. sexual abuse
4. emotional abuse
1

Health Problems of Early Childhood – Child Maltreatment | BSN 2-A RLE Groups 3 and 4 | Batch 2016
1. physical abuse – the infliction of physical injury as a result of punching
beating, kicking, biting, burning, shaking or otherwise harming a child

 Predisposing Factors

Parental Characteristics Environmental

Characteristics of the Child Characteristics

• parental history of • child's temperament • divorce

abuse or neglect • position in the • poverty
• isolation from famlity • unemployment
society and poor • ill or disabled • poor housing
supportive • degree of sensitivity
relationships • frequent relocation
to parental needs • alcoholism and drug
• teenage mothers
addiction
• low self-esteem
• inadequate
knowledge

Other Risk Factors:

 withdrawal from friends or usual activities
 changes in behavior such as aggression, anger, hostility, or hyperactivity
 changes in the school performance
 Depression, anxiety or a sudden loss of self-confidence
 an apparent lack of supervision
 frequent absences from school
 attempts of running away and suicide

Signs and Symptoms:

 unexplained injuries, such as bruises, fractures or burns
 injuries that don’t match the given explanation
 untreated medical or dental problems

Munchausen Syndrome by Proxy (MSBP)

- refers to illness that one person fabricates or induces in one another person
- one of the more unusual and perplexing types of physical abuse

 Incidents
o adding human blood to human urine to simulate hematuria
o presenting a fictitious medical history
o chronic poisoning of the child
o suffocating the child to cause apnea and seizures
 Common Presentations and Methods of Deception of MSBP

Presentation Mechanism

Apnea Suffocation, drugs, poisoning

Seizures Drugs, urine, asphyxiation

Fevers, blood infection Infection of feces, saliva, contaminated water into child

Vomiting Poisoning with drugs that cause vomiting

Diarrhea Poisoning with laxative, salt, mineral oil

2. sexual abuse – a form of child abuse in which an adult or older adolescent

uses a child for sexual stimulation

 Predisposing Factors
o a male the patient knows
o pedophilias or child molesters
o positions that involve working closely with the children
o socioeconomic factors
o incestuous relationships
o presence of a stepfather

 Signs and Symptoms

o sexual behavior or knowledge that’s inappropriate for child’s age
o pregnancy or a sexually transmitted infection
o blood in child’s underwear
o statements that he or she was sexually abused
o trouble walking or sitting
o abuse of other family mambers

 Types of Sexual Abuse

1. incest – any physical sexual activity between family members; blood relationship is
not required(abusers may include step parents, unrelated siblings, grandparents)
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2. molestation – a vague term that includes “indecent liberties”, such as touching,
fondling, kissing, single or mutual masturbation, or oral-genital contact.

Health Problems of Early Childhood – Child Maltreatment | BSN 2-A RLE Groups 3 and 4 | Batch 2016
3. exhibitionism – indecent exposure, usually exposure of the genitalia by an adult to
children or other adults

4. child pornography – arranging or photographing any sexual acts, either alone or

with adults or animals, regardless of consent by the child’s legal guardian

5. child prostitution – involving children in sex acts for profit and usually with
changing partners

6. pedophilia – literally means “love of child” and does not denote a type of sexual
activity but the preference of prepubertal children as the means of achieving sexual
achievement

3. child neglect – the failure of a parent, or another person legally responsible

for the child’s welfare to provide for the basic needs and adequate level of care

 Predisposing Factors
o physical abuse
o ignorance of child needs
o lack of resources
o poor parenting skills
o lack of knowledge

 Signs and Symptoms

o poor growth and or weight gain
o loss of self confidence or self-esteem
o lack of clothing or supplies to meet physical needs
o taking food or money without permission
o eating a lot in one sitting or hiding food for later

4. emotional abuse - includes all acts or omissions by the parents or other

caregivers that have caused, or could caused, serious behavioral, cognitive,
emotional or mental disorders
 emotional abuse is almost always present when other forms are identified

 Signs and Symptoms

o delayed or inappropriate emotional development
o loss of self confidence or self-esteem
o social withdrawal
o depression
o headaches or stomach aches with no medical cause
 II. CHILD MALTREATMENT AND THE PHILIPPINE
CONSTITUTION

1. RA 7610 - the policy of the State to protect and rehabilitate children gravely
threatened or endangered by circumstances which affect or will affect their survival
and normal development and over which they have no control.

2. Child Protection Program - a body charged with monitoring the

implementation of Republic Act No. 7610, "The Special Protection For a Child
Against Abuse, Exploitation, and Discrimination Act"

3. RA 9231 - the policy of the State to provide special protection to children from
all forms of abuse, neglect, cruelty, exploitation and discrimination

III. COMPLICATIONS
Some children overcome the physical and psychological effects of child abuse,
particularly those with strong social support who can adapt and can cope with bad
experiences. For many others, however, child abuse has lifelong consequences. For
example, child abuse may result physical, behavioral, emotion

Physical Issues Behavioral Issues Emotional Issues

o death
o physical disabilities
and health problems
o learning disabilities
o attention deficit/
hyperactivity
disorder(ADHD)
o substance abuse
o delinquent or violent o low self-esteem
behavior o difficulty establishing
o abuse of others or maintaining
o withdrawal relationships
o suicide attempts o challenges with
o frequent casual sex intimacy and trust
with many different
others

Health Problems of Early Childhood – Child Maltreatment | BSN 2-A RLE Groups 3 and 4 | Batch 2016
 IV. ASSESSMENT OF THE MALTREATED CHILD

 Characteristics of Abusers
a. male – usually a male the victim knows
b. child molesters – “pedophiliac”, are in the positions that work closely with the
patient
c. child’s own parents – associated in pornography and prostitution

 Characteristics of Victims (assessment)

a. history - date and time and place of occurrence, sequence of events with
recorded times, presence of witnesses, name age and condition of other children
in home
b. physical assessment – bruises, injury, pain and evidence of past injuries

Talking with Children who Reveal Abuse

8 1. Provide a private time and place to talk.

2. Do not promise not to tell; tell them that you are required by law to report
abuse.
3. Do not express shock or criticize them or their family.
4. Use their vocabulary to discus body parts.
5. Avoid any leading statements that can distort their report.

V. NURSING CARE OF THE MALTREATED

CHILD
1. Protect child from further abuse.
2. Support child.
3. Support family.
4. Plan for discharge.
5. Prevent abuse.

46. Which of the following children would be most at risk for abuse?

1)The child of a teenager living with her family and boyfriend.

 2)The child of new immigrant who is living with a large group of immigrants in the

community.

3)The child of a newly divorced parent who has been having difficulty paying the bills.

4)The child of parents who travels frequently for business and leave the child with a

caretaker.

47. Which of the children in this group would the nurse identify at greatest

risk for abuse?

1) A 4-year-old with Cerebral Palsy requiring 24-hour care.

2)A child with leukemia who requires frequent hospitalizations.

3)A child who lives with a parent who has AIDS.

4)A child who hits his brothers and sisters for attention.

The nurse encourages a new parent who lives in an older home to have her 5-year-old
child tested for lead poisoning. The nurse should instruct the parent that lead poisoning
in children can lead to

neurologic disorders.

<rationale>Encephalopathy and other neurologic disorders such as seizures may result if

the child has lead poisoning.

cardiac arrhythmias.

<rationale>Cardiac anomalies are not common in children with lead poisoning.

stomach disorders.

<rationale>Abdominal pain may occur because of the presence of lead in the stomach, but
stomach disorders are not common.

bone disorders.
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<rationale>Lead lines may occur in the long bones, but bone disorders such as arthritis or
osteomyelitis are not common in children with lead poisoning.

Health Problems of Early Childhood – Child Maltreatment | BSN 2-A RLE Groups 3 and 4 | Batch 2016