How to Recognize Child Abuse and Neglect

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And now, let's take a moment and talk about child abuse and neglect,

a subject none of us really want to talk about but is vitally important,

especially if you work in an industry where you might be mandated to be a reporter of abuse or neglect and we're going to cover that next.

First, let's find out a little bit of background about this subject.

According to the U.S. Department of Health and Human Services Administration for Children and Families,

child abuse and neglect is one of the nation's most serious concerns.

During 2008, an estimated 772,000 children were determined to be victims of abuse or neglect.

Now a majority of these victims, which is around 71%, were sufferers of neglect while 16% suffered physical abuse,

9% was sexual abuse and 7% suffered psychological abuse.

Now, depending on your state laws, you may actually have a legal requirement to report suspect abuse as a mandated reporter.

This requirement often includes teachers, daycare providers, EMS workers, coaches, camp staff, as well as other professionals.

Let's talk about abuse.

Abuse can occur in childcare centers, schools, religious institutions, recreational and athletic programs,

not to exclude camps, residential facilities and the worst part; even at home.

The most pre-dominant type of abuse would be neglect, followed by physical abuse and then sexual abuse.

Neglect is something that means despite available resources, the parent fails to provide food, clothing, shelter,

supervision or does not seek medical attention for serious illness or injury and this can happen for a

number of reasons but a family crisis such as a job loss or a serious illness to a caregiver or a divorce.

Neglect also results from chaotic households and no structure or routines or their homes may have very little space for the child.

So indicators might be that the child may be undernourished and is usually hungry.

They may often be lethargic and the child hasn't slept well.

Chronically they have injuries that you can attribute to a lack of supervision including be harmed by other people.

They might be beggers for food because of persistent hunger.

They have noticeably poor hygiene.

They're inappropriately dressed for the weather.

Frequent accidents and injuries.

They have a poor ability to relate to others.

They have poor self-esteem.

Maybe they have attachment difficulties or social problems and are reduced to poor social behaviors.

Maybe they have an inability to say no to inappropriate requests.

So these are all different ways we can start to look at neglect and notice that there is a problem.

For physical abuse, the physical abuse is any act that, regardless of intent, results in a non-accidental, physical injury to a child.

It can happen when a parent is frustrated or angry and strikes, shakes or even throws a child.

Physical abuse may be something also like an intentional, deliberate assault,

such as burning the child or biting or cutting, maybe even twisting of limbs.

Now all children get bumps and bruises but it's important to recognize when those bumps and bruises

may be the indication that there's physical abuse rather than just normal, childhood roughhousing.

But in all cases, consider the context.

Take into account the child's explanation of the injury, the child's age and behavioral changes that you notice in the child.

Now some of the following signs may indicate true physical abuse.

Questionable bruises and welts or other injuries on the face, around the lips and mouth,

on the torso, on the back, the buttocks and the thighs, in various stages of healing,

in other words, the bruises might be different colored, reflecting the shape of the object used to inflict the injury,

in other words an electric cord or belt buckle; you might be able to see that mark, consistent with human bite marks.

Questionable burns, like cigar or cigarette burns, especially on the soles, palms, the back or buttocks.

Sometimes we even see immersion burns, socklike burns where we've seen they've put the baby or child into the hot water.

Donut shaped burns on the buttocks or genitalia.

Burns, burn patterns, that are like electric stove burners, where they're round and circular or an iron.

Rope burns on arms and legs, neck or torso.

Questionable fractures to the skull, the nose, the face, in various stages of healing.

These all could indicate signs of physical abuse.

So, the questionable cuts and scrapes, either to the lips, the gums or the eyes,

to the external genitalia, could all be indicators of that type of abuse.

Some behavioral indications might be being uncomfortable with physical contact,

being weary of adult contact, being apprehensive when other children cry.

They may show emotional extremes like aggression or withdrawal.

They may be frightened of the parents themselves.

Being afraid to go home.

Arriving at school early or staying late, as if afraid to go home.

Reporting being hurt by a parent.

Complaining of soreness or moving uncomfortably.

Wearing clothing inappropriate to the weather, to cover the body.

Chronically running away from the home.

We see this especially with adolescents.

They may be reluctant to change clothes for gym activities.

Attempting to hide injuries or bruises.

So, how do you tell the difference between discipline, which is normal and abuse?

It's important that there be some distinguishing things between corporal punishment and abuse.

Corporal punishment, such as spanking, may be used a discipline technique by parents or guardians to teach appropriate behavior.

Discipline is a learning process; the goal is to teach appropriate behavior.

Abuse is not a learning process, the goal is to stop inappropriate behavior by inflicting pain and this is usually the result of anger and frustration.

So, how do you tell the difference between abuse and accidental injury?

Well, abuse and accidental injury can look similar but there are important differences.

Cuts and bruises caused by accidents normally occur in outside areas of the body, like the elbows and the knees.

Accidental injuries to soft tissue areas like the stomach and the buttocks are less likely.

If an injury happens often it's less likely to be an accident.

If multiple injuries are present, especially in different stages of healing, it's less likely to be an accident.

If a series of injuries appear in a pattern or resemble an object like an electrical cord or wooden spoon, the injury may have been inflicted.

If the child's caregiver's explanation is inconsistent with the facts then the injury would be a suspect.

Here's an example.

Steve, a ten year old boy, arrived at school with a bruise on his elbow and a scrape on his knee.

So, you ask him what happened and Steve says,

"I got hurt riding my bike when I hit a curb. I fell on the road."

He says his father gave him a spanking because he told him not to ride on the road.

Steve's father stated the same, exact thing when he picked Steve up from school and Steve was glad to see his father.

See, in this situation, abuse would not be suspected.

Steve's injuries are consistent with his explanation.

His father's explanation was the same and his injuries are on the outer, boney areas of the body, not the soft inner tissues.

Steve behaved normally with his father and had no bruises or injuries from the corporal punishment, again, indicating that this was probably not abuse.

Now, here's a second example.

You notice that Susie, a nine year old, is trying to hide from the other girls in the locker room when she changes into her gym t-shirt.

You notice that she has bruises on her upper arms and soft tissues as well as strap welts and bruises on her lower back in various stages of healing.

When you question her about it, she says,

"Well, I fell down the stairs."

She's very afraid that you might ask her mother about it.

You see now, in this situation, you should suspect abuse.

Susie's secrecy, her fear of her mother being called, the bruises on her upper arms and soft areas, the specific injury pattern,

and the evidence of the various stages of healing are all multiple indicators of possible abuse.

We're not trying to get anyone in trouble that shouldn't be, we're just trying to help those who are being abused.

Let's talk about sexual abuse.

It's a complex type of abuse with significant implications for the child victim.

Often there are no physical signs or behavioral indicators that can be seen or are subtle and attributed to other things.

Sexual abuse is a devastating breach of trust for the child.

The adult abuser usually tries to manipulate them into silence,

"This is our little secret."

With real or implied threats.

This type of manipulation is far beyond the child's ability to understand.

This is emotionally confusing to the child and will often create a wide range of emotional responses.

Sexual abuse can be defined as any illegal sexual act upon a child.

This includes incest, rape, indecent exposure, fondling, child prostitution, child pornography.

All of these would be wrong and illegal in the sexual abuse arena.

Indicators of child sexual abuse include expressions of age inappropriate knowledge of sex or sex behaviors.

Sexually explicit drawings or highly sexualized play.

Expressions of unexplained fear of a person or place.

Avoiding or attempting to avoid a familiar adult.

Nightmares, sleep interruptions, withdrawal, guilt,

"It's my fault."

They may also indicate shame.

They may have serious depression or maybe depression in general.

Anxiety, mood swings.

A child's statement that they're being abused.

One the strongest indicators of sexual abuse is a child's report and when a child says that he or she has been sexually abused,

take the statement serious.

Resolve doubt in favor of the child and error on the side of protection.

If it's not happening, justice will find that out.

How do you respond to the abuse?

Abusers often tell children that bad things will happen if they tell others about them.

It's a secret that is not to be shared.

Because of this fear, children are much more likely to share information in an indirect way,

hoping that you'll figure it out and figure out what they're trying to tell you.

Indirect disclosure might sound like this,

"My babysitter keeps bothering me."

Disguised disclosure might sound like this,

"What would happen if a girl was being touched in a bad way and she told someone about it?"

Disclosure with strings might be something like,

"I have a problem but if I tell you about it, you have to promise not to tell."

If a child wants to tell you something, listen to them.

Remain calm.

Encourage the child to tell you what happened but do not press for details beyond that which the child is willing to provide.

Don't promise you won't tell anyone else.

Let the child know that you may need to tell a person who can help them.

Remember, you are not responsible to prove that the abuse or neglect occurred.

You must only have a suspicion that a child is being abused or neglected.

If you have reason to suspect abuse has occurred then report the situation to a local child protective service office.

And if you're a mandated reporter, you have a legal responsibility to do that report.

In your case, there may be a policy that governs who actually makes a report to child protective services when abuse is suspected.

It is important that you know your reporting policies and procedures.

Don't shirk your responsibilities and please don't overestimate the strength and power

of a healthy relationship that is simply good discipline and training.

It's going to take discernment and wisdom on your part but when you do suspect true abuse because of multiple indicators,

you're acting on the part as a true rescuer for a child who may be in serious trouble.