boards with protruding nails, knives, or razor blades; danger of burns with pot handles turned out, irons left out, exposed heaters, and wood stoves; and objects placed at risk for falls such as on stairways. Other dangers include the presence and accessibility of poisonous substances in the home and a lack of use of car seats or safety belts when riding in the car. Injuries and maltreatment sustained by children includes bruises, fractures, lack of food, and inadequate supervision. Physician records note multiple visits for illness, injuries, or ingestions, child-behavioral and parental-coping problems, and emergency and hospital encounters (Olds, Henderson, Kitzman, & Cole, 1995).
Studies link birth defects, disability, and chronic illness with increased incidence of child abuse. A history of physical and/or sexual child abuse affects violent behavior in pregnant youth and adolescent mothers; violent and self-injurious behaviors are present. In a study of 58 pregnant adolescents and 93 young mothers, 50 percent reported a history of child abuse and 10 percent reported a suicide attempt within the last 12 months. Nurses are viewed as in a key position to provide preventive and health promotion services to these mothers (Koniak-Griffin & Lesser, 1996; Stanton, Seidl, Pillitteri, & Smith, 1994).
Abused children and their families are further traumatized by the disclosure of abuse, with the need for multiple tellings required by protective services, medical personnel, and law enforcement officials. Children may be told that they will remain with their mothers if they disclose details of their abuse, only to find themselves removed from their families
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