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Alerting Child Protective Services - International Nurses Association

When should you alert child protective services?  Essentially, if you have a question on whether you should, always err on the side of caution and contact them. Better to have a fit parent investigated, then to have a child continue to suffer abuse or neglect. 

A Saved Child

A mid-size hospital had a 7-year-old female admitted to the emergency room on a Friday night. The girl had a very concerned mom and step dad with her, in addition to her 3-year-old brother. The nurse asks how the little girl got the huge gash on her forehead, and the step dad quickly answered that her brother hit her with a metal toy truck. The nurse turned to the little girl, and she answered that he didn’t mean to do it. The nurse had an odd feeling, and stepped out of the room to alert her supervisor.The supervisor visited the room, interacted with the child and the parents, and returned to say everything appeared to be fine to her. The doctor did a complete examination, and also said she felt the family was concerned and the child did not appear to be in fear. The decision was made not to alert children services. The concerned nurse thought about this scenario for the next 2 days until she could no longer ignore it. She called child welfare and expressed her own personal concern regarding the child. 

Two days later the little girl returned to the emergency room with a social worker, she was getting a wellness check prior to going into foster care. The nurse was told that upon a surprise visit, investigators found this little girl locked in a utility shed. When they entered the shed, the child reminded them to be quiet or her mom would use the axe on them. Thinking back, the nurse could say with some certainty, the wound looked as though it could have come from an ax. After a complete examination, it was determined the child had been sexually assaulted as well, her mother lost custody of her and the younger child.  An aunt and uncle of the child’s deceased father stepped in an adopted the children, both the mom and step father went to jail. 

This was a case that two much trained people assumed all was ok, the family appeared to be very loving and concerned. The one nurse could not ignore her feeling, her intuition told her something was not right, and she reported her concerns. Ultimately her report saved this child from a deplorable situation, thankfully she had the confidence to take the lead and do as she saw fit. She was later rewarded at work for her action, and additional training was available for all employees, thanks to her. 

Of course, you want to respect your supervisor, and abide by their rules and recommendations, however when the welfare and safety of a child is involved, follow your intuition, if you are concerned, let child welfare investigate, it’s always better safe than sorry in such a case. 

Most hospitals have extensive training, especially for emergency room workers, so that they can detect and properly report suspected cases of abuse, for either children or adults. Children may have been coached on what to say and what not to say. If you can arrange a temporary separation from the parents, you may assure the child that they need to be honest, and that they are in safe hands. Many children will speak up at this point. Whatever the case, do not give up. If you suspect a problem, make sure the proper authorities are made aware, and follow up to ensure they investigated. Many child welfare agencies are overworked and understaffed. It never hurts to make sure a case does not slip through the cracks.


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