Child abuse is associated with later mental health concerns.
Risk factors for child abuse include: poverty, younger parents, single parent, parents with history of mental illness, parents with history of substance abuse, and living with adult non-relative. Of course, child abuse can happen in families without any documented risk factors. Family socioeconomic class often impacts whether a clinician suspects child abuse and PNPs need to be careful not to let their biases affect decisions regarding medical evaluation, radiologic screening, and child welfare reporting.
Any bruise on an infant who has not begun to cruise or walk should be closely evaluated, since bruising before these developmental milestones emerge is unusual. Bruising and injuries to the ear, feet, frenulum, genitals, hands, mouth, and neck need special consideration. Overlying bruising is more often not present in abuse-realted skull fractures and in lower extremity fractures. Head injuries should be suspected with unexplained seizures, vomiting, changes in neurological status or mental status, or scalp hematomas.
References and Resources:
Fingarson, A. & Pierce, M. (2012). Identifying abusive head trauma: Knowing what to look for can save babies from future harm. Contemporary Pediatrics, 16-24.
Gill, D. (2012). Identifying child abuse. Clinician Reviews, 22: 29-36.
Osofsky, J. & Lieberman, A. (2011). A call for integrating a mental health perspective into systems of care for abused and neglected infants and young children. American Psychologist, 66: 120-128.
Stacks, A. & Pare, T. (2011). Infants placed in foster care prior to their first birthday: Differences in kin and nonkin placements. Infant Mental Health Journal, 32, 489-508.