Introduction - Care of the Child and Adolescent
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The alarming rise in the case of child abuse and neglect on the global platform portrays it as a serious social cause of the contemporary world. The different types of harmful behaviour done against the children are referred to as child abuse. The process of child neglect or child abuse takes various forms; in many cases, it relates to the perversion or psychological problem of the abuser. Child abuse is a heinous crime and has a long-term and penetrating negative impact on the victim's mind. It often leads to psychological disorders in the future. This essay focuses on the description and recognition of the various physical abuses done to Jack and critically discusses the nurse's response to it. In addition, the study includes Adverse Childhood Experiences (ACE) and focuses on the long-lasting impact of the abuse on Jack.
Recognition and Description of Physical Abuse
Jack, being only a three-month-old boy, had serious physical injuries in the body, including a broken femur and bruised ankle. The child is too young for corporal punishment; however, the serious bruises on his body parts suggest excessive physical abuse done against him as opined by Read et al. (2018) that any physical violence which leads to the creation of scar in the body that lasts for more than a day is referred to as abuse. In this context, the infant has marked bruises on the ankle along with swellings and a broken leg. Excessive physical violence against the infant could also result in their death as they are very delicate. A baby of fewer than six months is referred to as an infant; at this stage, the body of the child is extremely delicate and needs special care and support. Any type of physical injury could permanently damage the body part of the infant (Tiyyagura et al. 2020). This type of spine chilling physical abuse in infancy is sure to have a strong negative impact on the mental wellbeing and psychological health of Jack. As per the scenario, it is found that the child was not struck with an open hand but with paddles, belts, sticks or any other harmful object. Hitting with sharp or heavy objects could permanently damage the delicate tissue or muscles of the infant, which could lead to a permanent disability of the body part, or in severe cases, it could lead to death as well.
The farce lies in the fact that Candice, the mother of Jack, is aware of the physical torture her child is being subjected to, but still, she tries to cover it up. She lies to others, saying that her child has fallen off from the bed last night, and that has resulted in the swelling, bruises and broken femur of the baby. Ashilah et al. (2020) have pointed out that infants are delicate; hence minor acts of violence such as dropping, throwing or shaking the child can have serious side effects. Intentional pain inflection, intentional burning or submersion of the infant in hot water is a few illustrations of criminal and inappropriate behaviour. Psychological studies have found that a person or an individual who has been born and brought up in a violent environment has a normal tendency of inflicting pain on others (Honda et al. 2020). These aggressive, short-tempered people have a problem in their anger management process; in such cases, intervention to these abuses at the initial stage can prevent the future repetitions of such violence or abuse done against children.
Response to the Abuse and Health Services
Jack is finally brought to a healthcare centre for the treatment of the broken femur and the other swellings and bruises in the body. James and Green (2018) have mentioned that in the healthcare centre, the infant is minutely observed by the nurse, who at the very first chance recognises the injuries as a result of physical violence. However, Candice, the mother of Jack, repeatedly sticks to her confession that the baby fell down the couch the previous night and, as a result, got seriously injured. The nurse understands that it is a case of child abuse and neglects; consequently, the wellbeing and safety of the child is getting compromised. Proper diagnosis of the behavioural and physical signs of abuse includes conduction of physical check-ups of the baby. Different X-ray tests, lab tests and observation of the behaviour of the child can clarify the symptoms of the suspected abuse cases. In this context, the nurse of the healthcare centre must initially negotiate with the parent of Jack and try to identify the problem (Boman et al. 2020). The infant is immediately given proper medical care and attention; the nurse also discusses the issue of child abuse with the doctor in charge of Jack.
The problem arises in this case as the child is only three months old and is too young to interact and express his feelings. So, no psychotherapy of the children can resolve this violent issue, and the psychotherapy could be conducted only on the parents. The child is too young is unable to reciprocate the cognitive and traumatic behaviour that she has suffered. Breitbart et al. (2018) has suggested that psychotherapy of the parents of Jack could be beneficial to comprehend the root cause analysis of the physical abuse or violence done against the infant. The nurse is responsible for reporting the crisis to the doctor and also to the senior hospitality management department. According to the requirement, the healthcare centre can conduct medical tests to prove the fact that the injuries of Jack are the result of physical violence and abuse hurled against him. The management could report the violent case to the police as well and take mandatory action against the guilty (Awaliah et al. 2019). The situational analysis must be done, and in case the parents refuse to take the proper care and responsibility of bringing up the child. The infant must be handed over to the child rehabilitation centre or to the governmental crèche.
Impact of Adverse Childhood Experiences (ACE)
The various types of physical abuse, emotional neglect and household dysfunction are encompassed under the Adverse Childhood Experiences (ACEs). Benjamin et al. (2021) has claimed that the different types of neurological changes may be the result of maltreatment of the child at the early stages. In order to do the specification of biomarkers, subsequent research is associated with the ACEs, which are correlated with mental disorders and premature death of infants. The rate of ACEs has increased with time. Surveys have found that 65 per cent of the adults were earlier subjected to ACE. The ethnic and racial minority groups are more subject to accelerating cases of ACEs (Cdc, 2022). The accelerating cases of ACEs have a potential traumatic impact on the mental wellbeing of the children; it can also be correlated with mental illness chronic health problems, such as obesity, diabetes mellitus, depression, heart diseases and so on. Prevention of ACEs can provide a better environment for adults and children to thrive; for this, the immediate recognition of the adults with a history of ACEs must be initially recognised.
ACE includes not only physical abuse but also encompasses emotional neglect or negative behaviour by the caregiver or parents. Brand and Fazzari (2018) have suggested that emotional neglect could lead to a reduction in the intelligence quotient (IQ) of the child, which can have serious fatal consequences in the future. Different types of abnormal behaviours such as listlessness, poor interactive skills, and disabled learning abilities are the common results of ACEs. For the proper upbringing of a child, providing a healthy and positive homely environment is required, which can be achieved by giving proper guidelines to the parents and limiting their scope of corporal punishment. In most cases, toxic stress results from community violence, racism, and lack of proper guidance from supportive adults or guardians. Excessive toxic stress is harmful to the development of the child, and it leads to long-term wear and tears on the brain and body of the child (McGruder, 2019). Surveys have found that in most cases, the damages done by ACEs are irreparable and have a long-lasting impact on the victim.
In case when the parents and adults fail to provide buffering protection to the children, hyperactivation of the stress hormone takes place in the child. As suggested by Boman et al. (2018), this has a direct ill impact on the neurological developments of the brain and interferes with the feedback mechanism, hormonal, and metabolic regulatory system of the body. Children subjected to ACEs have higher chances of suffering from depression, heart disease, psychological imbalance and early death. The cyclical impact of ACEs continues to have an impact on the community health as well and oftentimes leads to the development of chronic diseases. Centres for Disease Control and Prevention (CDC) has linked exposure to ACE as one of the top ten reasons accelerating the mortality cases of the world. Sexual abuses of the children are also included in ACE, which mainly occurs due to incarceration, mental illness, and parental separation (UNESCO, 2022). The brains of young children are constantly developing because they have delicate neurons, and the pattern of the axon potential and neurohormone release gets modified due to a hike in the toxic stress.
Surveys have also linked economic hardships and financial crisis among the parents as a major issue behind the hike in the cases of child neglect or abuse. These irresponsible parents heighten the risks of children staying away from schools. Henning-Smith et al. (2019) have stated that the development of certain mitigating strategies must be done to guide the parents against the ill practice of child abuse. Therefore, only the creation of a positively homely environment can be possible, which will lead to the healthy growth of the mind and body of the child. Workforce and commissions have been created to fight against traumatic performances and ACEs against children. Target treatment is being implemented on the international platform to strategies for a healthy environment for children and negating the harms of ACEs (Siahaan et al. 2019). The different governments have directed their Child Healthcare Departments to focus on the development of guidelines for parents to focus and care for the mental and physical health of their children.
The actions of childhood adversity pose threats and risks for the wellbeing of the children, and the adolescents have been recognised by caregivers, media and legislators across the world. However, the concept of ACE could be at times aligned with that of toxic stress, trauma and childhood adversity. As mentioned by Honda et al. (2020), the psychological and physical wellbeing and development of children are threatened under ACE. It could also lead to long-term mental and physical problems, which get accumulated over time and lead to chronic mental and physical disorders. The rising cases of parental separation, emotional neglect and divorce have added to the various social disadvantages. To date, no such screening tools have been devised to identify the childhood adversity cases, to overlook ethnic groups or racial groups. Trauma is a definite outcome of ACE cases; firm legislative steps must be taken by the government bodies to deal with the rising cases of atrocities. Activation of firm lawsuits must be done to discourage the conduction of such malpractices (Tiyyagura et al. 2020). The children and the adolescents are the future of the nation, so preservation of their mental and physical health is the duty of society and the government.
The rising case of child neglect and abuse has reached an alarming rate, so proper mitigating strategies must be developed to create a positive environment for the growth of children. ACE is associated with long-term impact on the mental and physical wellbeing of children. The healthcare departments must devise special guidelines for the parents to take proper care of the children. In the initial stage, if the children suffer from emotional neglect, sexual assault or physical abuse then it can lead to the development of chronic diseases and has direct effect on the psychological health of the patients. Psychotherapy of the caregivers and adults can save the children from a traumatic future life overshadowed by chronic mental and physical disorders.