Infants are the most vulnerable group when it comes to abuse and neglect, also classified as maltreatment. In 2019, children younger than 2 years old made up more than 28% of all reported cases of maltreatment. (US Department of Health & Human Services, 2021) In these cases, the most common type of abuse is neglect which can encompass failing to provide food, clothing, shelter, or other physical necessities, love, comfort, affection, access to needed medical care or education, or appropriate supervision. The second most common type is physical, followed by sexual and then psychological or "other." (US Department of Health & Human Services, 2021)

During the assessment of the infant, neglect may look like inconsolable crying or excessive tantrums, lack of eye contact or interest when being talked to or played with, altered sleep patterns, feeding or digestion problems (not enough weight gain or too much weight gain for their age),or self-soothing behavior such as rocking, chewing, head banging, or other odd or repetitive behavior. (Wotherspoon & Gaugh, 2008). Physical abuse may present as an injury to a non-mobile infant, bruising (especially along the torso, eyes and neck), or any injury that can't be explained. Sexual abuse would have signs and symptoms like swollen or bruised genitals, discharge from genitals, or reddened or bruised anus. Psychological abuse may be the most difficult to assess in an infant. The infant may seem very frightened of people, or very passive or withdrawn when trying to interact. (Healthy Children, 2021)

There are some cultural practices that may present as child maltreatment, but may not technically be considered as abuse. In some cultures they perform something called coining which can leave ecchymosis with a pine tree pattern, especially on the back. In a practice called moxibustion, herbs are burned near the skin and may leave cigarette-like burns. Caida de mollera may present as abusive head trauma, or more commonly known as shaken baby syndrome. (Killion, 2017) It is important to be culturally sensitive while also ensuring the child's safety.

As in most states, North Carolina is a mandatory reporting state. If a nurse suspects that maltreatment is occurring, they can make a report to the physician and then to the social worker. From there it can be forwarded to the Department of Social Services (DSS). The nurse can also make a direct report to DSS. In my county that information and the forms can be found at https://socialservices.nhcgov.com/abuse/.

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