Safety, Injury Prevention, and Child Maltreatment
Safety questions ask you to give developmentally matched injury prevention and to recognize and report maltreatment correctly.
Core rules
- Car seats: rear-facing until at least 2 years or the seat's rear-facing limit; then forward-facing with harness; booster until the seat belt fits, typically 4'9" and 8–12 years.
- Safe sleep: alone, on the back, in a crib with a firm mattress and no loose bedding, room-sharing without bed-sharing.
- Set the water heater to 49°C (120°F); fence pools on all four sides; store medications and poisons locked.
- Helmets for bikes and scooters; firearms stored unloaded and locked with ammunition separate.
- Maltreatment red flags: bruising in an infant who is not yet cruising, patterned or clustered bruises, spiral or femur fractures in a nonmobile child, injuries inconsistent with the history, and delay in seeking care.
- Nurses are mandated reporters: report reasonable suspicion, not proven fact. Document objectively with direct quotes and measurements; do not interrogate the child or photograph injuries outside protocol.
Worked example
A 3-month-old who cannot roll over has a 1 cm oval bruise on the cheek. A pre-cruising infant with a bruise is a sentinel injury; the differential is nonaccidental trauma until proven otherwise. The nurse obtains a full set of vitals, documents the bruise in centimeters with a body diagram, avoids leading questions, and reports to child protective services per state law. Telling the parents a report is being filed follows facility policy.
Traps
- Waiting for certainty before reporting.
- Documenting opinions such as "parents seem guilty".
- Asking the child detailed leading questions and contaminating the interview.
- Giving poison-control advice for a caustic ingestion without expert guidance.