In 2001, an estimated 903,000 children were the victims of abuse or neglect in the United States, according to the National Child Abuse and Neglect Data System, which is part of the Department of Health and Human Services (Child, 2003, 10). The data was gathered from all child protective agencies in the country. The agencies received a total of 2,672,000 reports of possible abuse or neglect for the year, and of these, 903,000 proved to be actual cases of abuse or neglect, out of which over 1,300 children died as a result of the abuse or neglect.
The Healthy People 2000 objectives of the Surgeon General and the American Nursing Association directed nurses to ôEnd Violence in the United Statesö by reducing homicides and abuse in children (Patterson, 1998, 49). The majority of cases filed by healthcare institutions of child abuse are of physical abuse, but emotional and sexual abuse, neglect, shaken baby syndrome, and fetal alcohol syndrome are also child abuse.
Physical abuse is defined as injury to a child inflicted by a caretaker, and includes hitting, kicking, shaking, throwing or dropping, pinching, biting, burning, twisting extremities, boxing ears, choking, grabbing, squeezing, pulling hair, poisoning, or the use of weapons (Patterson, 1998, 49). Abuse can occur at any age, but the majority of physically abused children are below age three (66 percent to 78 percent), and of those, as many as 30 percent are under age six months. Presenting injuries include head trauma, abdominal trauma, and fractures. Recognition of diagnostic characteristics consistent with child abuse is important in protecting the child from further abuse. Certain injuries send up ôred flagsö suggesting abuse, particularly in the case of burns, bruises, and fractures.
Bruising is normal in young children, particularly over bony prominences, such as on the arms, legs, and foreheads (Patterson, 1998, 50). Bruises over multiple body areas ...