Be Prepared: The Role of Nurses in Preventing Child Abuse
Posted by Julia Tortorice

In 2021, there were 38,013 reported cases of child abuse in Pennsylvania - that accounts for 14 reported cases per 1,000 children. That same year, the national average was 8.1 cases per 1,000 children.

While these numbers are distressingly high, they only account for reported cases. There are undoubtedly countless more instances taking place. These children often have no advocates to help protect them and prevent abuse.

How can we in the healthcare community help to support and protect these at-risk children? It comes down to understanding how to identify signs of abuse and how to effectively communicate about abuse so that swift action can be taken.


For nurses, understanding the warning signs of abuse can be critical.

Signs and symptoms of abuse and neglect can be broken down into three key areas: behavioral cues, symptom cues, and physical cues.

1 - Behavioral Cues

Behavioral cues refer to observed actions in children. These could be in response to an action a nurse is taking, like taking blood or checking temperature. Or, these could be general behavioral signs in or out of the hospital, like issues with speech or chronic school absenteeism.

Behavioral cues that could signal abuse include, but are not limited to:

  • fear, anxiety, clinging
  • nightmares, sleeping problems
  • poor concentration/distractibility
  • regressive behavior for age
  • withdrawal to touch, afraid of exam
  • overly compliant, especially with difficult or painful parts of the exam

2 - Symptom Cues

Symptom cues refer to medical symptoms that could come up during a medical exam. These symptoms could point to direct impacts of abuse, or stress-related bodily reactions to abuse.

Common symptom cues among abused children include, but are not limited to:

  • headaches
  • abdominal pain, chronic and acute
  • worsening medical problems, such as asthma
  • frequent, unexplained sore throat
  • abnormal weight gain or loss
  • vomiting, irritability or abnormal respiration which may represent head trauma

3 - Physical Cues

The third category of abuse warning signs are physical cues. These are identifiers that nurses may notice when meeting with children that might not show up in the child’s chart.

Physical cues in children potentially suffering from abuse include, but are not limited to:

  • poor hygiene
  • dressed inappropriately for weather
  • failure to thrive, poor weight gain, malnutrition
  • lack of care of medical needs; wound care, medication
  • burns – (in 6-20% of abused children)
  • traumatic hair loss

Understanding and being able to recognize behavioral, symptom, and physical cues is a crucial first step in helping to support victims of abuse.


In addition to recognizing warning signs of abuse, it’s also necessary for nurses to be appropriately trained in how to communicate with their staff about potential signs of abuse.

When abuse is suspected, who do you talk to? How do you frame that conversation? What information is important to bring to the table? What kind of records should you keep?

Nurses play an invaluable role and have a unique perspective into spotting signs others may miss. Nurses may have alone time with children, and may potentially hear more candid responses or information surrounding the child’s home life and what’s led them to come in for care.

Once a nurse spots behavioral, symptom, or physical cues that could indicate abuse, it’s important that they share the information they have with their team. Direct confrontation with a child/parent can feel like the right route, but it could potentially negatively impact the child.

It’s critical that nurses move forward in these situations with confidence and care. A misstep here can be costly, and could ultimately cause harm.

That’s why Pennsylvania has set continuing education requirements for nurses pertaining to child abuse and neglect.

Continuing Education

Nurses face new challenges every day. Just because you’ve yet to experience some part of the job, doesn’t mean you won’t experience it tomorrow.

Nurses enter their careers for a number of reasons, but one reason that exists for every healthcare worker: is the desire to help others.

Investing the time to be able to appropriately identify and care for children potentially suffering from abuse is a critical piece to achieving that mission.

For nurses in Pennsylvania, can help you achieve your continuing education requirements, and ensure you are prepared to help children who are potentially facing abuse at home.

If you would be interested in learning more about our offerings and signing up to take our online courses, visit:

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