Child Abuse Recognition & Reporting
Overview
Child abuse recognition hinges on pattern recognition: injuries that don't match the child's developmental stage or the caregiver's stated mechanism. Nurses are mandatory reporters in all 50 states and report reasonable suspicion, not confirmed abuse. No proof, parental consent, or provider order is required. Investigation belongs to child protective services and law enforcement, not the nurse.
Interpretation
Suspicious findings vs. benign or developmental look-alikes. "Babies who can't cruise don't bruise" — any bruise in a non-mobile infant is suspicious.
Accidental vs. suspicious bruising
Accidental
- Location
- Shins, knees, forehead (bony prominences)
- Child mobility
- Mobile/cruising child
- Healing stages
- Single uniform stage
- History match
- Consistent, plausible mechanism
Suspicious for abuse
- Location
- Torso, ears, neck, buttocks, genitalia
- Child mobility
- Non-mobile infant (any bruise)
- Healing stages
- Multiple stages = repeated injury
- History match
- Inconsistent or changing story
Technique
When you suspect abuse
- Recognizepattern inconsistent with history or development
- Protectkeep child in safe, supervised setting
- Report to CPSdirectly; suspicion, not proof
- Documentobjective findings + verbatim quotes
Patient Teaching
Clinical Pearl
TEN-4: bruising on the Torso, Ears, or Neck in a child under 4 — or ANY bruise in an infant under 4 months — demands investigation. You report suspicion, not proof.