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Sentinel injuries (SIs) are some of the earliest and most readily identifiable red flags of child abuse. SIs are unexpected bruising or intra-oral injuries in premobile infants and highly correlated with child abuse. However, SIs are not always recognized and reported as red flags of child abuse. Infants are left at risk for continued harm when SIs are not identified and reported. Although increasing nurses' knowledge of SIs is important, child abuse researchers and behavioral theorists have identified that knowledge alone does not predict nurses' behaviors when identifying and reporting suspected child abuse. Other predictors may include implicit biases, interpersonal and interprofessional relationships, and nurses' understanding of mandatory reporting laws. Nurses may improve their recognition and comfort of reporting SIs and all suspected child abuse by being alert for SIs, being aware of potential implicit biases, communicating in non-technical language with families, understanding the clinical evaluation of suspected child abuse, and understanding the processes of Child Protective Services (CPS). Using these steps, nurses can fulfill their legal and ethical responsibilities to protect and advocate for victimized children.
Key Words: Child abuse, sentinel injuries, child abuse reporting.
Sentinel injuries (SIs) refer to specific child abuse injuries. The term sentinel injuries was first used in the context of child abuse in 2013 and is defined as unexpected bruising and intraoral injuries in pre-mobile infants (Sheets et al., 2013). Bruising and intra-oral injuries in pre-mobile infants are rare because the lack of mobility in young infants prevents accidental self-inflicted injuries. However, bruises and mouth injuries often do not require clinical intervention. Therefore, they can be overlooked by both parents and health care providers (HCPs) as trivial injuries. Thus, the term sentinel injuries was adopted to describe the importance of these early injuries as red flags of abuse and to change the way nurses, other HCPs, mandatory reporters, and parents think about them (L. Sheets, personal communication, September 22, 2017).
The word sentinel suggests military action because it speaks to the need for vigilance or standing guard (Merriam-Webster, 2022). Within health care, The Joint Commission (TJC) defined sentinel events as unanticipated events resulting in patient death, permanent harm, or life-threatening temporary harm. To protect patients, occurrence of a sentinel event signals the need for immediate investigation and response...