Wednesday, April 27, 2011

Child Abuse Injuries: Part 1/2

I read a lot of ficiton. Okay, suspense fiction. What I find missing is an area that seems to be in few books yet inherently has a lot of conflict. Child abuse. What fiction titles are you aware of that as a central theme center around child abuse?

April is Child Abuse Awareness Month so I thought I'd do a few posts about child abuse injuries and how medical providers pick up on the fact an injury may be intentional or inflicted. As a pediatric nurse, I've been witness to child homicide at the hands of abuse. Yes, it is murder. It's a necessary part of my job in dealing with these families, perhaps even the confessed abuser, as I care for the child abuse victim. And yes, there is a lot of conflict in these situations.

How do we as pediatric medical providers begin to suspect that an injury is abusive? During the initial evaluation of an injury, confession among abusers is rare (perhaps, they will confess later). There is often a history given to account for the injury. Both parts: the history of the injury and the injury itself can give red flags for child abuse. Today, let's examine the story and how it may signal an abusive injury. On Friday, we'll look at the injury itself.

The story concerning the injury:

1. Is not realistic considering the child's developmental level. This is more common than you might think. Most people cannot rattle off when a child should meet certain developmental milestones so they'll say the child injured themselves in a manner that is beyond their developmental level. For instance, "my daughter broke her arm by rolling off the couch". The baby is two-weeks old. Infants typically roll over starting at 3 months. Here's a great resource for any writer/parent for developmental milestones:

2. The story changes. Just like criminals, abusers can have a hard time keeping their story straight. Often times, the more abusers are questioned about the plausibility of the story, it will begin to change. Medical staff interviewing a potential abuser can be like a detective getting a criminal to confess. The doctor will often approach the caregiver several times to ask questions about the injury to see if the story changes. In latter interviews, the doctor may say, "This injury is suggestive of abuse."

3. The story has too much detail. This one may seem odd but it can be a red flag for abusive injuries. If you have children, think back to their toddler/elementary school years when they seem to come home with lots of bumps, bruises, cuts and scrapes. If asked, could you come up with an explanation for each and every injury? Likely, no. Abusers will try and explain away every injury. A non-abusive parent will be truthful and likely say, "I have no idea how that happened." and then probably feel guilty about not knowing.

What other part of a medical history/story might give a signal for abusive injury?


  1. Have you read Gerrie Ferris Finger? I reviewed an excelent book of hers last year, The End Game. It deals with missing/exploited children. Can't say enough about it.

  2. Hi Jordyn!
    As a women's health nurse practitioner with a strong pediatric background also, I've sadly encountered child abuse all too often also. I remember reading White Oleander and the Glass Castle (non fiction) and being very grieved at children's plights.

    Like your points about what to or not to include in a story. A cild's behavior-ie-extreme 'startle' responses or nervous mannerisms (tics, biting nails)can provide clues and be useful writing techniques.

    Nice idea for a blog!

    Jude Urbanski

  3. Robert, thanks for the book tip. I'll definitely check it out. Jude, good addition about observing the child's behavior. It's always a good part of the total clinical picture.

  4. Excellent post, Jordyn !!!!!

    99% of the time when someone is injured or killed, it's by a loved-one. It's rarely by some ominous stranger. When I’m on scene of a 911-call, experience has taught me to be suspicious of the family first. In order to best treat the patient, my scene size-up and knowing the details of what happened is vital.

    CONGRATS again on your sale,

  5. Jordynn, from an editor/writer point of view, child abuse stories can be harder to sell. When I wrote a book about a kidnapped child, some of my friends refused to read it - they were moms, and they just didin't want to deal with the idea. It's still one of my lowest selling books, and other writers have told me similar stories.

    Hard on us writers, but in a strange way, it's comforting to know that abuse is such a foreign thought to a lot of parents that they don't even want to read a novel that features it.

  6. Dianna--- yes, many times it is a close family member. For shaken baby syndrome, research has shown in order of most likely on down: mother's boyfried, father, mother then babysitter as far as offenders. Neglect is often deadlier than "simple" abuse.

    Ramona--- your comment is so interesting to me and I think it highlights a major societal issue. People don't want to believe that people hurt kids. This is why jury conviction can be so difficult at times. First, you have to surmount the general belief that everyone first loves their children and will always do what is best.

    This is not always the case.

    I sense a new blog idea coming...