When a child comes to the emergency room there is a
certain protocol that is followed. The
possibility of a case of child abuse must be ruled out when an injury has
occurred. What can contribute even more
stress is when there are two parents present, they are not together, and not in
agreement over the child. Tensions are
elevated, and in the middle of it all can be a child in need of an X-ray or
sutures.
How
to Handle the Parents
Your priority is the patient, the child. The parents cannot be a major concern
until such time the childis examined and is deemed to be ok.
-
Ask, or direct if necessary, the parents to
go into a private consult room to have their discussion. Offer to have security accompany them to
ensure neither party feels threatened or in danger. Inform the parents they may return once they
have settled things and can turn their focus to the child. The parents should not be allowed to remain
in the room if they are in a heated discussion.
-
If there are additional parties with the
parents, it's likely to add to the conflict at hand. Suggest that immediate family members only
remain with the child that will most likely lessen the tension.
- Depending on the child's age, discuss the
injury, how it happened, and who was with them when it happened. Avoid saying did someone hurt you, as the
child may have been coached to say no one.
By asking who was with them, they may answer more openly.
-
Always call social services if there is any
question regarding the child's safety.
There is never a time that you can over-react when a child may be in
danger. Call for assistance and let
authorities do an investigation to ensure the child's safety.
It is an all too common occurrence to have an injured
child in the emergency room, and the parents are upset, perhaps blaming one
another, and more importantly upsetting the child. In most cases, it's best to have security
standing by to ensure the safety of everyone.
A nurse working in an emergency room recalls an
incident from early in her career. A mom
brought her 9-year-old daughter to the emergency room with pain in her abdomen
and a fever. Tests showed the child had
a urinary tract infection, and when the nurse was explaining this to the child,
her mom stepped out to make a phone call. The nurse picked up on it when the child said she probably got the
infection from her neighbor. This sent
up red flags, as it should have. The
nurse alerted security that the child could not be discharged until social
services arrived, and the mom was told more tests were being ordered. As it turned out, the girls 17-year-old
neighbor was sexually abusing her, and threatening her not to let anyone
know. Her slip to the nurse set the
investigation into action, and saved this patient from further abuse. The girl’s parents had no idea, and were
devastated, luckily it came to an end as the neighbor was arrested.
This above case involved someone outside the family,
however keep in mind that there are times a family member may be suspected of
abuse. Always observe the juvenile
patient and pay attention to anything said that may cause suspected abuse.
Child abuse is at least recognized now and talked
about. Children are taught in school
what abuse is, and what is and is not acceptable touching. Teachers, coaches, nurses, counselors, and
anyone working with children are trained to recognize a potential case of
abuse, and to alert proper authorities. As a nurse, you often have a better idea of repeated and unexplained
injuries, so it falls to you to speak up anytime you suspect a problem. Remember, a loving parent will understand and
appreciate your concerns, and for the child’s sake it's better to be safe than
sorry.
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