Failure to report reasonable suspicion is illegal; the nurse must report even without certainty.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse caring for a child notices injuries inconsistent with the explanation given by the parents and suspects child abuse. Which action reflects the nurse's legal responsibility?
Answer: A. Nurses are mandated reporters of suspected child abuse and must report reasonable suspicion to child protective services or the designated authority, even without proof. Good-faith reporting is legally protected. Failing to report suspected abuse can result in legal penalties and continued harm to the child.
Question 2 of 5
A parent asks whether they can give their child a leftover antibiotic from a sibling for similar symptoms. What is the nurse's best response?
Answer: B. Medications are prescribed by weight and specific condition for one child. Sharing antibiotics risks wrong drug, wrong dose, allergic reactions, and antibiotic resistance. The nurse should teach the parent never to share prescriptions.
Question 3 of 5
A child weighs 22 lb. What is the child's weight in kilograms for dosing purposes?
Answer: B. To convert pounds to kilograms, divide by 2.2. 22 divided by 2.2 equals 10 kg. This is the correct value to use in mg/kg calculations.
Question 4 of 5
A pregnant nurse is assigned a group of pediatric patients. Which child should she avoid caring for to protect her fetus?
Answer: A. Rubella (German measles) is teratogenic and can cause congenital rubella syndrome if a nonimmune pregnant woman is infected, especially in the first trimester. A nonimmune pregnant nurse should not care for a child with rubella.
Question 5 of 5
An adolescent is in the clinic to receive vaccines. Per the routine schedule, which vaccine series is recommended to begin at age 11 to 12 years?
Answer: B. The HPV vaccine series is routinely recommended starting at age 11 to 12 years, along with Tdap and meningococcal conjugate. The primary DTaP and Hib series are completed in infancy and early childhood, and the rotavirus series is given only in infancy.
Keep the streak going with more questions like these, each with a full rationale.
What is child abuse recognition?
Nurses are mandated reporters legally required to report reasonable suspicion of abuse, regardless of proof. Key principle: the hallmark of abuse is an injury that does not match the reported mechanism or the child's developmental stage.
Key points to remember
- An injury inconsistent with the stated history or with the child's developmental ability is the key red flag.
- Bruises in various stages of healing, and injuries to protected areas (back, buttocks, ears, neck, genitals) suggest abuse.
- Patterned injuries (loop, cigarette burns, immersion 'stocking-glove' burns) and spiral fractures in non-ambulatory infants are suspicious.
- Shaken baby syndrome causes retinal hemorrhages, subdural hematoma, and altered consciousness, often without external marks.
- Behavioral cues include fear of the caregiver, flat affect, regression, and wariness of physical contact.
- Neglect appears as poor hygiene, untreated conditions, failure to thrive, and missed appointments.
Signs & symptoms
- Bruises various healing stages
- Patterned marks, immersion burns
- Spiral fractures, retinal hemorrhage
Nursing priorities
- Ensure the child's immediate safety and stay calm and nonjudgmental with the family.
- Report reasonable suspicion to Child Protective Services or authorities; reporting is mandatory and does not require proof.
- Document objective findings precisely: size, color, shape, and location of injuries, with quotes from the child and caregiver.
- Interview the child separately and use open-ended, nonleading questions.
- Use body diagrams and, when protocol allows, photographs to record injuries.
Labs & values
Patient teaching
- Teach families nonviolent discipline and age-appropriate expectations for behavior.
- Educate caregivers that shaking an infant can cause permanent brain injury or death.
- Connect families with parenting support, respite, and community resources to reduce stress.
Red flags: report now
- Failure to report reasonable suspicion is illegal; the nurse must report even without certainty.
- Retinal hemorrhages with altered consciousness in an infant suggest abusive head trauma and require emergency workup.
- A delay in seeking care or a changing/inconsistent story about the injury is a major warning sign.
- Never confront or accuse the caregiver or promise the child secrecy.
References
Clinical references for this topic
