NG-360

🛡️ Recognizing & Reporting Child Maltreatment

What raises suspicion, how to document it, and why suspicion alone is enough.

👀 What raises suspicion

A child drawn twice - one shading the areas children normally bruise, the shins, knees, elbows and forehead, and one shading the areas that raise concern: the torso, ears, neck, buttocks and inner thighs. — Where the bruise is matters more than what it looks like. TEN-4: torso, ears, neck in a child under four. Swipe it sideways if it is cut off, or tap to open it full size.

The single most important indicator is a history that does not fit the injury — or a history that changes between tellings.

Category	Concerning findings
Bruising	On torso, ears or neck in a child under 4; any bruise in a baby not yet cruising; patterned marks — belt, hand, cord
Burns	Stocking or glove distribution; sharp waterline edges; cigarette-sized circles; symmetrical burns
Fractures	Spiral fracture in a non-walking child; fractures at different stages of healing; rib, femur or humerus in an infant
Head	Retinal hemorrhages; subdural bleed with no adequate explanation
Behavior	Watchfulness, flinching, indiscriminate affection, or no distress at painful procedures
Context	Delay in seeking care; blaming a sibling or the child; inconsistent accounts

🧠 Neglect looks different

Often the more common and more easily missed form: failure to thrive, poor hygiene, untreated dental decay, missed appointments and immunizations, inappropriate clothing, unsupervised young children.

🩺 What the nurse does

✅ The four things

1Keep the child safe and treat the injuries

2Document objectively — measure, describe, quote

3Report — nurses are mandatory reporters

4Support the child; stay calm and matter-of-fact

⭐ Documenting well

Describe, do not interpret: “3 cm oval purple bruise on left upper arm”, not “grab mark”
Measure every lesion; note color, shape and exact location; use a body map
Quote the child verbatim, in their own words, in quotation marks
Quote the caregiver’s explanation verbatim too — the mismatch is the evidence
Photograph per policy; note who was present

🚨 The rules that get tested

Suspicion is enough. You do not need proof, and you do not investigate - that is the agency's job.
Do not confront or accuse the caregiver. It can escalate risk to the child and compromise the investigation.
Never promise a child you will keep it secret. Say you will have to tell people whose job it is to keep them safe.
Reporting in good faith is legally protected, even if the concern turns out to be unfounded

💬 Talking with the child

Interview alone where possible, in a quiet room
Open questions only — “Tell me what happened.” Never lead or suggest
Use the child’s own words for body parts
Do not repeat the interview — repeated questioning distorts a child’s account and can harm the case
Reassure them it is not their fault, and that telling was the right thing

🧠 A note on shaken baby / abusive head trauma

An infant with unexplained irritability, vomiting, poor feeding, a bulging fontanelle, seizures or reduced consciousness and no clear history needs abusive head trauma considered.

Prevention teaching: normalize that infant crying peaks around 6–8 weeks, and that it is always safe to put the baby down in the crib and walk away for a few minutes.

🎯 NCLEX traps

History that does not match the injury is the key finding
Spiral fracture in a non-walking infant → report
Suspicion is enough; you do not investigate
Do not confront the caregiver; do not promise secrecy
Document with measurements and direct quotes

Sources. Written from CDC, HealthyChildren.org (AAP), MedlinePlus and OpenStax A&P 2e (CC BY 4.0).