When interviewing parents of an injured child, which of following is strongest indicator that child abuse may be a problem?

Correct Answer: A. The injury isn’t consistent with the history or the child’s age.

When the child’s injuries are inconsistent with the history given or impossible because of the child’s age and developmental stage, the emergency department nurse should be suspicious that child abuse is occurring. Physical indicators may include injuries to a child that are severe, occur in a pattern or occur frequently. These injuries range from bruises to broken bones to burns or unusual lacerations. The child may present for care unrelated to the abuse, and the abuse may be found incidentally.

• Option B: The parents may tell different stories because their perception may be different regarding what happened. If they change their story when different health care workers ask the same question, this is a clue that child abuse may be a problem. Physical abuse should be considered in the evaluation of all injuries of children. A thorough history of present illness is important to make a correct diagnosis. Important aspects of the history-taking involve gathering information about the child’s behavior before, during, and after the injury occurred. History-taking should include the interview of each caretaker separately and the verbal child, as well. The parent or caretaker should be able to provide their history without interruptions in order not to be influenced by the physician’s questions or interpretations.
• Option C: Child abuse occurs in all socioeconomic groups. All races, ethnicities, and socioeconomic groups are affected by child abuse with boys and adolescents more commonly affected. Infants tend to have increased morbidity and mortality with physical abuse. Multiple factors increase a child’s risk of abuse. These include risks at an individual level (child’s disability, unmarried mother, maternal smoking or parent’s depression); risks at a familial level (domestic violence at home, more than two siblings at home); risks at a community level (lack of recreational facilities); and societal factors (poverty).
• Option D: Parents may argue and be demanding because of the stress of having an injured child. To diagnose a patient with child maltreatment is difficult since the victim may be nonverbal or too frightened or severely injured to talk. Also, the perpetrator will rarely admit to the injury, and witnesses are uncommon. Physicians will see children of maltreatment in a range of ways that include the perpetrators may be concerned that the abuse is severe and bring in the patient for medical care.