3 Child Abuse and Neglect Nursing Care Plans

You are legally and morally obligated to identify a child who may be maltreated and to report it. Miss it and the child goes back to the same environment. This is your job, not a judgment call you get to defer.

What is Child Abuse?

Child abuse is any neglect or mistreatment of an infant or child: emotional pain, physical injury, or sexual exploitation. It is most often inflicted by the child's biological parents. Others implicated include foster parents, babysitters, boyfriends, friends, and daycare workers.

Neglect is the most common form. It means deprivation of basic physical or emotional needs: food, clothing, shelter, healthcare, education, affection, and nurturing. Emotional abuse stems from rejection, isolation, or terrorizing the child.

Physical abuse shows up as burns, bruises, fractures, lacerations, or poisoning. Infants can suffer shaken baby syndrome, with severe or fatal neurologic injury from violent shaking; look for 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 infections. The biggest red flag is a discrepancy between the child's injuries and the reported cause.

Nursing Care Plans and Management

The planning goals: ensure adequate nutrition, keep the child safe, support the child and family emotionally, and build parenting skills and confidence.

Nursing Problem Priorities

1. Safety assessment and protection.
2. Emotional support and trauma-informed care.
3. Collaboration with the multidisciplinary team for full evaluation and intervention.

Nursing Assessment

Assess for the following subjective and objective data:

• Fear, anxiety, or distress
• Reports of physical pain, discomfort, or injuries
• Feelings of worthlessness, guilt, or shame
• Disclosure of abuse to a trusted adult or clinician
• Bruises, burns, fractures, or scars
• Signs of neglect: poor hygiene, inadequate clothing, malnourishment
• Behavioral changes: aggression, withdrawal, or regression
• Delayed developmental milestones
• Evidence of sexual abuse: difficulty walking or sitting, genital injuries, sexually transmitted infections
• Poor academic performance or attendance
• Caregiver behavior that is inconsistent, neglectful, or abusive
• Reports of abuse from school personnel, neighbors, or social services

Nursing Diagnosis

Formulate the diagnosis from your assessment and clinical judgment. Labels matter less here than the priorities they point to: safety, nutrition, anxiety, and trauma prevention.

Nursing Goals

Goals and expected outcomes may include:

• The child shows no further weight loss and, if malnourished, gains 2.2 lb (1 kg) per week.
• The child makes eye contact, has relaxed facial features, and reports decreased anxiety if age-appropriate.
• The parent demonstrates appropriate parenting behaviors.
• The parent provides a safe environment.
• The parent builds a positive relationship with the child and holds realistic expectations for self and child.
• The child does not experience further maltreatment by parents or other offenders.

Nursing Interventions and Actions

1. Improving Nutritional Status

Neglect, inadequate intake, and limited access to food leave abused children malnourished, with long-term effects on health and development.

Assess for signs of malnutrition. A malnourished child shows decreased attention span, confusion, pale and dry skin, subcutaneous tissue loss, dull brittle hair, and a red, swollen tongue and mucous membranes.

Assess and record the amount, consistency, and color of stools and emesis. Guides nutrient absorption.

Monitor intake and output and food intake. Weigh the child daily. Tracks calories consumed and the progress of nutritional therapy.

Maintain good oral hygiene before meals. Promotes appetite and improves the taste of food.

Encourage parents to help the child during feeding. Eating as self-care builds self-esteem.

Encourage small, frequent feedings high in carbohydrates and protein. Small meals reduce fatigue and are easier to tolerate.

Encourage adequate rest. Reduces fatigue and improves appetite.

Consider enteral or parenteral nutritional support as indicated. For children who cannot maintain intake by mouth.

Refer to a dietitian or nutritional support team. Individualizes the diet within any prescribed restrictions.

2. Reducing Anxiety

Abused children live in fear, hypervigilance, and insecurity. Ineffective parenting makes it worse, leaving them without the emotional support or protection they need to cope.

Assess the child's level of anxiety and fear, how it shows, and the source. Note reactions to staff and parents at each contact. Tells you what is driving the anxiety and gives a baseline to judge improvement.

Encourage the child to express concerns and fears. Answer questions honestly at the child's developmental level. Releasing feelings lowers anxiety.

Show affection and acceptance even if the child ignores or rejects it. Do not reinforce negative behavior. Builds trust and positive behavior.

Provide consistent staffing, ideally staff who relate well to the child. Builds familiarity and trust.

Provide a play program with other children, set aside one-on-one time, and reward desired behavior. Shapes behavior through interaction and reinforcement; builds self-esteem.

Use a therapeutic play kit to walk the child through any procedure (dolls, syringes, tubing, dressings). Familiarity reduces anxiety.

Treat injuries without treating the child as a victim. Do not interrogate or force discussion. Pressing the child about abuse raises anxiety and stress.

Explain every treatment and procedure and its purpose, and tell the child someone will go with them to other departments. Preparation prevents fear.

Refer the child for counseling as indicated. Supports the child in dealing with abuse.

Assess the parents: their own developmental tasks, understanding of the child's growth and development, bonding and attachment, how they interpret and respond to the child, and how they meet the child's social, psychological, and physical needs. Identifies parenting patterns that lead to abuse and parents at risk for violence.

Give parents room to express feelings, needs, and goals. Do not judge or compare them to other parents. Supports parents in meeting their own needs.

Praise parents for participating in care and tell them when they are caring for the child well. Reinforces positive parenting and builds confidence.

Model child-nurturing behavior for parents to imitate. Teaches parenting skills.

Include parents in planning care and setting goals. Keeps them involved in meeting the child's needs.

Teach parents to reduce conflict, stay consistent, and avoid siding with the child or each other. Promotes a healthier child-parent relationship.

Teach developmental tasks for the child and the parents and what is appropriate at each age. Helps parents respond realistically to the child's needs.

Tell parents to maintain their own health: rest, nutrition, exercise, leisure, and social contact. Parents who meet their own needs care for their children better.

Refer to community agencies offering parenting classes and support groups. Provides parenting education.

Initiate referrals to social services, parenting classes, or counseling. Tell parents that child protective services has been contacted, and keep them informed of the child's status unless custody is removed. Provides options when parenting is inadequate.

3. Preventing Trauma

Abused children carry physical, emotional, and psychological harm that can lead to anxiety, depression, post-traumatic stress disorder, and trouble forming healthy relationships later.

Assess the abuser for violent or abusive patterns, alcohol or drug use, and other psychosocial problems. Identifies warning signs of abuse.

Assess how parents behave toward the child: responses to behavior, ability to comfort, feelings and expectations, and over-protectiveness. Reveals characteristics that indicate risk.

Document factually and objectively: the child's physical condition, behavioral responses to parents and staff, the parents' responses, and interviews with family. This record may be used in legal action.

Communicate the child's needs to the abuse team or new caretakers, with written care instructions. Carries the care plan forward based on the court's decision.

Teach parents to identify what triggers abuse and how to handle the child's behavior without harming them. Prevents further abuse.

Tell parents about followup care and the need to monitor the child's progress. Keeps the focus on care and preventing recurrence.

If the child is placed in foster care, tell the parents and let them meet the new caretaker. Prepares parents for a court-ordered placement that keeps the child safe.

Give parents the contact for Parents Anonymous and other child protective groups. Provides self-help, information, and support matched to the type of abuse.

Refer to a social worker, public health nurse, or counselor before discharge home. Supports the child and family and monitors behavior after discharge.