Recognizing Child Abuse and Neglect
An abused or neglected child is one whose physical or psychological
health or development is harmed by the parents' (or caretaker's)
behavior. The law defines child abuse to include physical abuse,
physical neglect, sexual abuse and emotional abuse of a child under
18 years of age by a parent- or by another family member or caretaker.
Physical Abuse
- The non-accidental physical injury of a child inflicted by a
parent or caretaker, which ranges from superficial bruises and
welts to broken bones, burns, serious internal injuries and, in
some cases, death.
- You may see frequent and unexplained bruises, burns, cuts,
injuries; the child may be overly afraid of the parent's reaction
to misbehavior.
Physical Neglect
- A parent or caretaker's failure to give the child food, clothing,
hygiene, medical care and supervision.
- You may see a very young child routinely left alone at home.
You may know that a severe illness or injury is not being medically
treated. A neighbor child may frequently turn up at your door
inadequately dressed for the weather saying their parent told
them to stay away. Physical neglect can be hard to judge; sometimes
what you see is poor judgment, but not neglect. Sometimes what
you see is the result of poverty, not parental neglect.
Sexual Abuse
- Ranges from offenses such as promoting prostitution, to fondling,
intercourse, or using the child for pornographic materials.
- You may observe sexual behavior way beyond what is expected
for the child's age; a young child might have sudden, unusual
difficulty with toilet habits; there may be pain or itching, bruises
or bleeding in the genital area. The child might tell you.
Emotional Abuse
- Includes severe rejection, humiliation, and actions intended
to produce fear or extreme guilt in a child.
- You may see a parent who verbally terrorizes the child, who
continually and severely criticizes the child, or who fails to
express any affection or nurturing
Indicators of Physical Abuse
Special attention should be paid to injuries that are unexplained
or are inconsistent with the parent's or caretaker's explanation
and/or the child's developmental stage.
Note: "Behavioral indicators" of child abuse have a valid
place in decision making. Particularly when there is otherwise unexplained
change in behavior, these indicators provide important clues for
potential reporters to pursue, and crucial corroborative evidence
of maltreatment. But, behavioral indicators tend to be misused to
report suspected abuse, without physical or other evidence and without
statements of the child or others. Any list of behavioral indicators
standing on their own and without an accompanying history of past
and present behaviors, should not be the basis of a report. There
are too many other explanations for such behavior. (Besharov, Douglas,
Recognizing Child Abuse, A Guide for the Concerned, The Free Press
1990.)
Physical Indicators
I. Bruises welts and bite marks
- on face, lips, mouth, neck, wrists or ankles
- on torso, back, buttock, thighs
- injuries to both eyes/cheeks (accidents usually injure only
one side)
- in clustered, forming patterns
- in shape of article (e.g. belt, cord)
- on several different surface areas
- evidence of human bite (compresses rather than tears)
- in various stages of healing
- regularly appearing after absence, weekend, vacation
II. Lacerations or abrasions
- to mouth, lips, gums, eyes,
- to external genitalia, on back of arms, legs or torso
III. Burns
- cigar, cigarette, esp. on soles, palms, back, buttocks
- scalding water immersion (sock-like, glove-like, doughnut shaped
on buttocks or genitalia)
- patterned like electric iron, iron, etc.
- rope burns on arms, legs, neck, torso
Behavioral Indicators
- Wary of contacts with parents or other adults
- Apprehensive when other children cry
- Behavior extremes
- aggressiveness, withdrawal, or extreme mood changes
- Afraid to go home, repeated incidents of running away
- Reports injury by parents (sometimes blames self, e.g., "I
was bad")
- Habit disorders
- self-injurious behaviors
- psychoneurotic reactions (phobias, compulsions, obsessions,
hypochondria)
- May wear long sleeves or other concealing clothing inappropriate
for weather, to hide injuries
- Manifestations of low self-esteem
- Suicide attempts
Sexual Abuse of Children - Defining the Problem
The sexual exploitation of a child by a parent, relative, caretaker
or other person, which may range from non-touching offenses such
as exhibitionism to fondling, intercourse or use of child in the
production of pornographic materials.
Indicators of Sexual Abuse
Because most sexual abuse cases do not present apparent physical
evidence or indicators, identification and recognition are often
very difficult. And, the many legitimate fears which child victims
of sexual abuse experience make it extremely difficult for them
to report the abuse, even to a very trusted adult or friend. The
fact that the vast majority of child molesters are family members
or friends of the child or his/her family makes disclosure of the
abuse very difficult for the child. There is absolutely no profile
of a child molester or of the typical victim. Do not assume that,
because an alleged offender has an unparalleled reputation for good
works in the community or holds a certain job, he or she could not
also be a child molester.
Note: "Behavioral indicators" provide important clues for
potential reporters to pursue, particularly when there is otherwise
unexplained change in behavior. But, behavioral indicators should
not be the basis of a report without physical or other evidence
or statements of the child or others.
Physical Indicators
- Difficulty in walking or sitting
- Torn, stained or bloody underclothing
- Pain or itching in genital area
- Bruises or bleeding in external genitalia, vaginal or anal
areas
- Bruises to the hard or soft palate
- Sexually transmitted diseases, especially in preteens; includes
venereal oral infections
- Pregnancy, especially in early adolescent
- Painful discharge of urine and/or repeated urinary infections
- Foreign bodies in vagina or rectum
Behavioral Indicators
- Unwilling to change for gym or participate in physical education
class
- Withdrawal, fantasy or infantile behavior
- Bizarre, sophisticated or unusual sexual behavior or knowledge;
seductive or promiscuous behavior
- Poor peer relationships
- Delinquent or runaway; truancy
- Reports sexual assault by caretaker
- Prostitution
- Forcing sexual acts on other children
- Extreme fear of being touched; unwilling to submit to physical
examination
- Self-injurious behaviors; suicide attempts
- Manifestations of low self-esteem, general fearfulness
Neglect & Maltreatment of Children - Defining the Problem
Physical Neglect
The withholding of, or failure to provide a child, adequate food,
shelter, clothing, education, hygiene, medical care and/or supervision
needed for normal growth and development.
Summary of Legal Definition: A neglected child is a child
less than eighteen years of age whose physical, mental or emotional
condition has been impaired or is in imminent danger of becoming
impaired as a result of the failure of the parent- or other person
legally responsible for his/her care- to exercise a minimum degree
of care:
- in supplying the child with food, clothing, shelter or education,
or medical, dental optometrical or surgical care, though financially
able to do so or offered financial or other reasonable means to
do so; or
- in providing the child with proper supervision or guardianship,
by unreasonably
inflicting or allowing to be inflicted harm, or a substantial risk
thereof, including
the use of excessive corporal punishment; or
- by misusing drugs or alcohol to the extent that he or she loses
self-control of
his/her actions, or
- by any other acts of similarly serious nature requiring the
aid of the court; or
- who has been abandoned by his/her parents or other person legally
responsible for the child's care.
Emotional Neglect
Acts or omissions that cause or could cause serious conduct, cognitive,
affective or other mental disorders as a result of such parent or
caretaker behavior as torture or close confinement or the constant
use of verbally abusive language to harshly criticize and denigrate
a child; generally a result of the child's inability to meet unrealistic
demands made by parents. Also includes emotional neglect -- the
withholding of physical and emotional contact to the detriment of
the child's normal emotional development, and in extreme cases,
physical development.
Summary of Legal Definition: "Impairment of emotional health"
and "impairment of mental or emotional condition" includes a state
of substantially diminished psychological or intellectual functioning
in relation to, but not limited to, such factors as failure to thrive,
control of aggressive or self-destructive impulses, ability to think
and reason, or acting out and misbehavior, including incorrigibility,
ungovernability or habitual truancy; provided, however, that such
impairment must be clearly attributable to the unwillingness or inability
of the parent or other person legally responsible for the child to
exercise a minimum degree of care toward the child.
Indicators of Neglect And Maltreatment
Note: "Behavioral indicators" of child abuse have a valid
place in decision making. Particularly when there is otherwise unexplained
change in behavior, these indicators provide important clues for
potential reporters to pursue. But, behavioral indicators alone
and without an accompanying history of past and present behaviors,
physical or other evidence or statements of the child or others,
should not be the basis of a report. There are too many other explanations
for such behavior.
Physical Indicators of Neglect
- Failure to thrive (physically or emotionally)
- Positive indicator of toxicology, esp. in newborns; drug withdrawal
symptoms, tremors, etc.
- Lags in physical development
- consistent hunger, poor hygiene (skin,teeth, ears, etc.)
- Inappropriate dress for the season
- Speech disorders
- Consistent lack of supervision, especially in dangerous activities
or for long periods
- Unattended physical problems or medical needs
- Chronic truancy
- Abandonment
Behavioral Indicators of Neglect
- Begging, stealing food
- Extended stays at school
- Constant fatigue, listlessness, falling asleep in class
- Alcohol or drug abuse
- Delinquency (i.e., thefts)
- States there is no caretaker
- Runaway behavior
- Habit disorder (e.g., sucking, biting, rocking)
- Conduct disorder (e.g., antisocial, destructive)
- Neurotic traits (sleep disorders, inhibition of play)
- Psychoneurotic reactions (hysteria, obsession)
- Behavior extremes; compliant/passive aggressive
- Overly adaptive behavior, adult-like or infantile
- Lags in mental/emotional development
- Attempted suicide
Possible Behavioral and Environmental Characteristics of Abusive
Parents or Caretakers
These indicators are clues, not conclusive proof. Although they
are useful to remember when dealing with the parent/caretaker, these
characteristics also exist where a child is not abused or neglected.
Typically, several clues or indicators will appear, rarely as separate
entities. Except for the obvious, single clues should be treated
as "flags" which indicate that the professional needs to look further
and more carefully.
Parent / Caretaker History
- Parent abused or neglected as a child
- Lack of friendships or emotional support
- Isolated from supports such as friends, relatives, neighbors,
community groups
- Lack of self-esteem, feelings of worthlessness
- Marital problems of parents, including spouse abuse
- Physical or mental health problems, irrational behavior
- Life crises: financial debt, unemployment / underemployment,
housing problems, etc.
- Alcohol / substance abuse
- Adolescent parents
Parent - Child History
- Parent's unrealistic expectation of child's physical and emotional
needs
- Mentally/developmentally disabled children are particularly
vulnerable
- Parent's unrealistic expectations of child to meet parent's
emotional needs (role reversal), children viewed as "miniature
adults"
- Absence of nurturing child-rearing skills
- Violence/corporal punishment accepted as unquestioned child-rearing
practice
- Violence accepted as a normal means of personal interaction
- Delay or failure in seeking health care for child's injury,
illness, routine checkups, immunizations, etc.
- Parent views child as bad, evil, different, etc.
Environmental
- Lack of social support
- inability to ask for and receive the kind of help and support
parents need for themselves and their children
- Homelessness
Helping the Child
Recognizing Disclosures - School or Agency
Very seldom will a child disclose abuse immediately after the first
incident has occurred. Victimized children often experience a great
sense of helplessness and hopelessness and think that nobody can
do anything to help them. Also, victimized children may try to make
every attempt to protect an abusive parent. Or, they may be extremely
reluctant to report any abuse for fear of what the abuser may do
to them. Typically, a child may not report abuse for months and
even years, particularly if the abuser is someone close to the child.
Sometimes an outcry may not be verbal but portrayed in a drawing
left behind inadvertently for the teacher, the counselor, or a trusted
relative to see. Another form of outcry may be seen in a child who
will frequently go to the school nurse complaining of vague, somatic
symptoms, often without organic basis, hoping that the nurse will
guess what has happened. This way, in their minds, they have not
betrayed nor will they be punished, since they did not directly
report the abuse. Some children, while totally reluctant to report
or discuss the abuse, may be more willing to express their apprehensions
and anxieties about the perpetrator or the home situation. In some
cases, abused children will make an outcry which may take the extreme
form of a suicide gesture or attempt.
Children may disclose abuse in a variety of ways. They may blurt
it out to you, especially after you have created a warm nurturing
environment. They may come privately to talk directly and specifically
about what is going on. But more common ways include:
Indirect Hints: "My brother wouldn't let me sleep last
night." "My babysitter keeps bothering me." A child may talk in
these terms because he/she hasn't learned more specific vocabulary,
feels too ashamed or embarrassed to talk more directly, has promised
not to tell, or for a combination of these reasons.
Appropriate responses
would be invitations to tell you more, such as "Is it something
you are happy about?" and open-ended questions such as "Can you
tell me more?" or "What do you mean?" Gently encourage the child
to be more specific. It is important that the child use his/her
own language, and that no additional words are given to the child.
Disguised Disclosure:
"What would happen if a girl told someone her mother beat her?"
"I know someone who is being touched in a bad way." Here the child
might be talking about a friend or sibling, but is just as likely
to be talking about her/himself.
Encourage the child to tell you what he/she knows about the "other
child." It is probably that the child will eventually tell you about
whom he/she is talking.
Disclosure with Strings Attached:
"I have a problem, but if I tell you about it, you have to promise
not to tell anyone else." Most children are all too aware that some
negative consequences will result if they break the secret of abuse.
Often the offender uses the threat of these consequences to keep
the child silent.
Let the child know you want to help him/her. Tell them, from the
beginning, that there are times when you too may need to get help
with the problem. In order to help them, it may be necessary to
get some special people involved. The fact that the child has chosen
this particular moment to disclose is important. Usually they will
agree to seeking help if you talk about it ahead of time. Assure
the child that you will respect his/her need for confidentiality
by not discussing the abuse with anyone other than those directly
involved in getting help. And, if you can explain the process to
them, it may help with their initial fear.
Responding to Disclosures
In school, if a child discloses during a lesson, acknowledge the
child's disclosure and continue the lesson. Afterward, find a place
where you can talk with the child alone. It is best to present child
abuse curricula before a playtime or recess so that you have a natural
opportunity to talk with children privately if they come forward.
Before notifying anyone outside of your school or agency, you
or another designated person:
..should sit down in a quiet room without interruptions and speak
with the child. If a child has chosen you as the person in whom
to confide, you should take the time to speak with the child about
the problem. If that is not possible, ask the child if she/he would
feel comfortable discussing it with someone else. If the child indicates
that he wants to tell you, you must make every effort to listen
and support the child. She/he may not trust another enough to tell
them.
Multiple interviews should be avoided. The child will have to share
the story with many others.
When you speak with the child, sit down together, assure him/her
that you are concerned and want to know more and that it's alright
to tell you. Go slowly, allowing the child to explain as much as
he/she can. Do not suggest in any way that any particular person
may have done something to him/ her or that the child was touched
in any particular way. Let the child talk as much as possible.
Explain, in age appropriate language, that the law requires you
to make a report if any child discloses abuse and that the law is
there to protect them. Describe for them who will be involved, for
example, the social worker, principal and the CPS caseworker.
When Talking to the Child, DO
- Find a private place to talk with the child.
- Sit next to the child, not across a table or desk.
- Use language the child understands; ask the child to clarify
words you don't understand.
- Express your belief that the child is telling you the truth.
- Reassure the child that it is not his/her fault, and that he/she
is not bad and did nothing to deserve this.
- Determine the child's immediate need for safety.
- Let the child know you will do your best to protect and support
him/her.
- Tell the child what you will do, and who will be involved in
the process.
When Talking to the Child, DON'T
- Disparage or criticize the child's choice of words or language.
- Suggest answers to the child.
- Probe or press for answers the child is unwilling to give.
- Display shock or disapproval of parent(s), child, or the situation.
- Talk to the child with a group of interviewers.
- Make promises to the child, about "not telling" nor about how
the situation will work out.
Supporting the Child After the Report Has Been Made
If it is necessary for Child Protective Services or a Law Enforcement
official to interview the child at the school or agency, you should
cooperate and assist by providing access for such an interview.
Unless there are compelling reasons against it, a staff member the
child trusts should be present during the interview to provide support
for the child. (This situation may also arise when the report did
not originate from your school or agency.)
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