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Workbook Activity #1
Case #1 - Suspected Child Abuse
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Two-month-old Brandon sees a public health nurse at a child health clinic for his rst immunizations.
His mom reports he is fussy, spits up frequently and is dicult to feed. She mentions that she tried a dierent
formula without success. e nurse notes that while Brandon’s weight gain is adequate and his development
appropriate, the mom is concerned. e nurse advises the mom to take Brandon to see his family doctor. She
also discusses strategies for managing fussiness and gives Brandon his immunizations. She arranges to follow
up with the mom and Brandon in two weeks.
A follow up visit:
At the next visit, the nurse notes that Brandon has a dime-sized bruise on his le cheek. e mom says
Brandon’s three-year-old brother hit him with a toy. e mom also says that she and the dad nd Brandon’s
crying stressful. She admits that yesterday the dad became quite angry and pushed her. When the nurse
questions her further, the mom states that the dad gets angry but has never threatened or hurt her. e dad
loves Brandon and she’s sure he would never hurt him. ey take turns with Brandon when he is crying so
they each get a break. e nurse is concerned and gives the mom a domestic violence resource card. ey talk
about having a safe place to go. Brandon looks well and the mom seems condent. She advises the mom to
more closely watch the three-year-old with the baby. She discusses strategies for managing a crying baby. en
she arranges a home visit in two weeks.
When the nurse arrives for the scheduled visit, no one is home. e nurse leaves her card with a note for the
mom to call. She also calls the mom’s cell phone and leaves a message.
An emergency department visit:
ree weeks later, the mom brings Brandon to a nearby emergency department. His mouth is bleeding. He is
weighed, briey assessed by the triage nurse and seen by the physician. Brandon’s upper frenulum is torn. e
mom explains that Brandon accidentally bumped heads with the dad while feeding. e physician says this
should heal with no problem. Brandon looks well – his bruise has disappeared and the mom doesn’t mention
it. Because it is late on a Friday night, a social worker is not available. Brandon is discharged.
A few days later, the public health nurse tries again to follow up with Brandon and his mom. She leaves a
message on the mom’s cell phone.
Back in emergency:
Brandon is four months old when he arrives at the emergency department by ambulance. His mom says she
found him unresponsive and seizing earlier that morning. His condition is serious. He has severe abusive
head trauma, including bilateral subdural hematomas, retinal hemorrhages and four old rib fractures of two
dierent ages.
Brandon survives but is le with permanent neurological damage.
