Baby Adam: Nurse Responsibility in Child Abuse

As a naïve nursing student from rural Kansas, my first pediatric rotation in Kansas City was an exciting adventure but one with great life lessons.  Being there for about two months, I felt confident in my ability to care for children in the toddler section.  We had taken care of abnormalities such as spina bifida, hydrocephalus, prematurity and cardiac problems, but no amount of class lecture and study had prepared me for my first patient of child abuse.

Baby Adam, not quite two, was admitted with burns - not from an accident, but by his mother who had poured boiling water on him since he would not stop crying.  About 60 percent of his little body was burned, with only the top of his head unharmed.  There was nothing that could be done for him except try to keep him pain free and comfortable.  The only thing that helped was to sit and rock him.  You could not hold him against you to cuddle but had to hold him away from you by your hand on top of his head.  Needless to say, as we rocked, we both cried many tears.  Other students took over at the end of the shift, but unfortunately, he did not make it through the night.  All of us as nurses have situations and patients that stay with us for ever.  Baby Adam is one of those.

Throughout my nursing career, I have tried to make a difference in this area but have found that I am best at prevention and education of parents.  I applaud nurses who can work with the parents and the children directly.  I, like every nurse, should take our responsibility seriously for being advocates for our patients – especially those who can not defend themselves.

Child abuse is an issue that knows no boundaries, just like socio-economical levels, race or education.  The Centers for Disease Control and Prevention (CDC) reports that in 2006, 1,530 children died in the United States from abuse and neglect, and 905,000 children were victims of maltreatment.  The Child Welfare League of America (CWLA) reports that in 2006, Arkansas had 35,376 referrals for child abuse and neglect, and of those, 23,120 reports were investigated.  In that same year, 6,078 children were substantiated as abused or neglected, with 55.7 percent considered neglected, 19.3 percent were physically abused and 29.2 percent were sexually abused.  Unfortunately, 17 children died in 2005 as the result of child abuse in Arkansas.

Besides being a moral, ethical and professional responsibility of nursing to be an advocate for children’s welfare, it is a legal responsibility to report suspected child abuse.  Nurses in Arkansas are mandated reporters, according to Arkansas Code Annotated § 12-12-507.

To report a suspected case of child abuse, call 1.800.482.5964.  I encourage each of you to visit the new mandated reporters Web site: http://www.Arkansas.gov/reportarchildabuse/.  The Web site includes excellent information to update you with facts of child abuse and the expectations of being a mandatory reporter.

Remember our responsibilities to the Adams of the world!

Calvina Thomas, PhD, RN,is the Assistant Director of Nursing Education in Arkansas