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Although all age groups are subject to abuse, infant abuse is often the most difficult to identify and report. Abused infants frequently suffer from neglect and from physical trauma. The reason it is so difficult to identify infant abuse is because infants have no way to convey what has happened to them, and the person who perpetrated the abuse is often in contact with medical staff, controlling the story. For this reason, recent research indicates that almost half of abuse cases are missed during medical screening (Guenther, Powers, Srivasta, & Bonkowsky, 2010).

This information begs the question of what can be done to increase awareness of the signs of abuse among medical staff. The most obvious solution to this problem is continued education an ongoing training. Vomiting, irritability, or a call to 911 can be signs of abuse and may be associated with abusive head trauma (Guenther et. al, 2010). Training programs must consider this information so that it becomes common knowledge and nurses are more aware of what to look for during treatment.

While many of the aforementioned signs are objective, interpretation of cultural variations in health practice can be very subjective and can be misidentified as child-abuse. Some cultures practice religious restrictions that severely limit the type of medical care that maybe administered to underage believers. This can result in conflict between the families of patients and attending medical staff. These situations have even resulted in legal proceedings and loss of custody. Another example of cultural variation is the administration of superstitious remedies, such as coining in the Thai culture. This holistic religious practice can leave marks that are similar in appearance to bruises. An awareness of these kinds of practices can prevent the misreporting of abuse and can help establish trust between nurses in patients.

Where I work in the state of California, mandatory reporting is a legally required in cases of suspected or reported child abuse. Hospital policies fall in line with state law and require reporting to local law enforcement and the Department of Children and Family Services within 24 hours. Such a report also initiates the response of Social Services for in-home follow-up. While these laws and policies are critical to protect children, they cannot be carried out without awareness and courage, which begins with the attending nurse.