Plausible Deniability: Child Abuse


Unfortunately, as a pediatric ER nurse, it is part of my job to deal with abhorrent parts of family life. The parts that the average citizen doesn’t think about on a daily basis. Maybe even they deny what is in front of their very eyes.
What I know to be true is that children are abused. Their most likely abusers are those closest to them. Mothers. Fathers. Boyfriends. Caregivers. It is not the stranger on the street that comes in, shakes your infant, and then disappears into the night.
When I began working in the pediatric ICU (PICU) what surprised me most was not that children were abused but that the general public didn’t believe it and it was very hard to get people convicted on child abuse charges for just that reason. It wasn’t that there wasn’t sufficient evidence . . .  it was that the jury simply couldn’t believe that a mother, any mother, would willfully press her child’s hand to an iron and hold it there.
Surely, that was accidental.
Maybe you have suspicion that a child you know is possibly being abused but you’re afraid to take that step of contacting someone in a position to help. You may say to yourself– I don’t really know what the signs of child abuse are– and I don’t want to put anyone through needless accusation.
So, what are some of the classic signs of child abuse? I’ll list some here. Remember, one of these symptoms in isolation doesn’t always indicate abuse (thought it also may) but the more items on this list that you see– the more likely is the possibility the child may be being injured. I’m going to focus on physical abuse.
1. Bruises over non-bony prominences. Common childhood bruising occurs to the knees, shins, elbows, and forehead. These tend to be the areas that children fall onto. Bruising to the buttocks, abdomen, back would be areas that are not bony prominences. Now, one bruise to the buttocks may not be indicative but multiple bruises to the buttocks– particularly in a diapered child– is concerning.
2. The bruise has a shape/pattern to it. Think about all the bruises you’ve seen on a child. They are typically round, irregularly shaped– and over a bony prominence. Bruises with a pattern are often inflicted. It takes force to imprint the pattern onto the skin. Think of a bullet. There is much more damage inflicted on a person if I fire it from a gun versus if I just hold it between my fingers and tap you with it.
3. The history does not match the injury. Think about what a child should be able to do normally. Say you have a neighbor with a two-week-old baby who always is bruised up. She says the baby just keeps rolling off the couch. One, a child of that age cannot do that developmentally. This should be red flag #1. Also, any bruising to the face, head, and neck of a child who is not yet pulling up to stand is concerning because– how are they hurting themselves if they aren’t falling down?
So, take some of these things into consideration when you are concerned about a child who may be being abused. Most of all, if you’re gut is telling you something is wrong– listen to it. You may be the only adult who will stand up for that victim and actually save a life.

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