· Introduction
· Physical Abuse: Symptoms and Behaviors
· Neglect: Indicators and Behaviors
· Sexual Abuse: Indicators and Behaviors
· All Forms of Abuse
· Questions for Mandated Reporters

Introduction

CHILD ABUSE ALERT is addressed to two groups of people — the friends, neighbors and family members of children at risk, and the community of people who work professionally with children and are mandated to report abuse and neglect.

Adults who want to help a child they suspect is being abused face a difficult dilemma. On one hand, they worry about making an unfair accusation. On the other, they worry that if they don’t act, a child could be harmed. This booklet is designed to help you recognize some of the signs that a child is at risk, and to give you the confidence to act. Note that many of the indicators and behaviors described in this booklet may exist in families in which there is no abuse. Also, families in which there is abuse do not necessarily exhibit these characteristics.

This booklet will discuss three types of child maltreatment and the characteristic indicators and behaviors that will help you identify each.

PHYSICAL ABUSE occurs when a parent or caretaker inflicts, or allows another person to inflict physical injury to the child. In its most extreme forms, physical abuse is easily detected. However, there are usually many warning signs and less severe incidents of abuse that occur before serious injuries are inflicted. A timely response can make the difference.

NEGLECToccurs when, regardless of cause, a parent or caretaker does not provide necessary food, clothing, shelter, education, supervision or health care for a child. Neglect is the most frequent form of child maltreatment, and may cause more long-term damage than many cases of physical abuse. Extreme physical neglect is easily identified, but even less obvious cases also may result in significant, long-lasting consequences for a child.

SEXUAL ABUSE is a general term describing behavior by adults or older children that seduces or coerces a child into sexual contact, including sexual molestation, incest, sexual assault, or involvement in pornography. Sexual abuse is more difficult to identify than other kinds of maltreatment, as it usually can be suggested only by behavior or learned through a child’s disclosure. A physical examination may be necessary for certainty.

Physical Abuse: Signs and Symptoms

CHILD: Physical Indicators

• · Bruises and welts
• · Bite marks
• · Choke marks and abrasions
• · Burns
• · Fractures
• · Loss of hair or bald spot
• · Unexplained or vaguely explained injuries
• · Several injuries, bruises or broken bones in various stages of healing

CHILD: Behavior

• · Tells teachers or others of being injured at home
• · Explanation of injury is inconsistent
• · Cringes or flinches when touched
• · Seems wary of adults
• · Wears long sleeves or other concealing clothing (often inappropriate for season)
• · Stares vacantly
• · Fears going home or runs away
• · Is unusually aggressive with peers or younger children

PARENT/CARETAKER: Behavior

• · Uses discipline which is inappropriate or extreme for the child’s age or behavior
• · Conceals child’s injuries and fails to obtain medical care for injured child
• · Avoids contact with authorities and is reluctant to share information about child with them
• · Refuses consent for medical examination/ diagnostic testing
• · Uses many different medical facilities
• · Regularly criticizes or threatens child
• · Keeps child out of sight
• · Consistently singles out one child in family as bad in comparison with others
• · Discourages social contacts
• · Has unrealistic expectations of child

Neglect: Signs and Symptoms

CHILD: Physical Indicators

• · Apparent malnourishment
• · Unattended physical needs, medical, dental, etc.
• · Clothing that is inappropriate for season
• · Constant fatigue, listlessness
• · Chronically dirty and unkempt
• · Developmental lags
• · Significant weight loss

CHILD: Behavior

• · Begs or steals food
• · Is frequently late, absent or truant from school
• · Reports that there is no caretaker at home
• · Uses alcohol or drugs
• · Bites, sucks or rocks beyond toddlerhood
• · Demands either constant attention or seeks no attention
• · Is inattentive or has short attention span

PARENT/CARETAKER: Behavior

• · Leaves child with inadequate caretakers
• · Appears intoxicated or high
• · Allows child to engage in dangerous activities
• · Maintains excessively dirty, dangerous, barren or chaotic home
• · Denies child medical treatment
• · Permits child access to inappropriate substances
• · Ignores child’s bids for affection and attention
• · Regularly fails to keep appointments concerning child’s needs

Sexual Abuse: Signs and Symptoms

CHILD: Physical Signs

• · Physical Bruises, bleeding or abnormalities in genital or anal area
• · Venereal diseases, vaginal or urinary tract diseases
• · Pain or itching in genital area
• · Difficulty in walking or sitting
• · Distressing dreams, nightmares or sleep disturbances
• · Eating problems
• · Frequent wetting or soiling after toilet training has been achieved

CHILD: Behavior

• · Has unusual sexual knowledge
• · Exhibits seductive or promiscuous behavior
• · Shows extreme interest in his or her sexual organs, in other children’s, or in parents’
• · Persists in inappropriate sexual play
• · Seems unusually fearful of particular person or setting
• · Masturbates excessively
• · Avoids being touched or is overly desirous of physical contact
• · Acts overly suspicious, watchful or fearful of physical examination
• · Exhibits either regressive or falsely adult behavior
• · Demonstrates dramatic behavior change, such as a large drop in school performance

PARENT/CARETAKER: Behavior

• · Has a history of sexual abuse offenses
• · Appears hypervigilant and repressive about issues related to sexuality
• · Uses multiple medical facilities
• · Is physically intrusive with child
• · Acts as though child is either much older or younger than age
• · Discourages social contacts
• · Views child as a possession

All Forms of Abuse

FAMILY RISK FACTORS: Parent/caretaker and family characteristics that often are present in cases of maltreatment

• · Was neglected or abused as a child
• · Has drug or alcohol problems (any family member)
• · Was sexually abused as a child or adolescent
• · Has little or no contact with extended family or other supportive adults
• · Is unfamiliar with normal child development or disciplinary techniques
• · Has chronic illness, physical or mental disability (any family member)
• · Has had multiple relocations or changes in house- hold membership
• · Lives in overcrowded or inadequate housing
• · Has had loss of employment or other source of income

Questions for Mandated Reporters

If you are a mandated reporter (caseworker, teacher, healthcare worker, etc.), the following questions may be useful to help gather information from children and caretakers to determine risk:

Questions for Mandated Reporters to Engage Children

• · What do you like most about yourself?
• · What do you feel proud of?
• · What do you do that makes your parents proud of you?
• · How do they show you they are proud of you?
• · What do you do that makes your parents angry or worried?
• · How do they show you that they are angry or worried?
• · What happens when you do something wrong?
• · What kinds of things worry you about yourself?
• · What kinds of things worry you about your family?
• · What do you do when you are scared?
• · Who do you talk to when you are sad or worried?
• · When you do something great, who do you tell about it?

Questions for Mandated Reporters to Engage Parents, Foster Parents, or Other Caretakers

• · What about your child do you like best?
• · How does your child make you proud?
• · What do you do when you are pleased with your child?
• · What did you do as a child that upset your parents?
• · What do you do when your child upsets you?
• · How do you punish your child?
• · What are your greatest worries about your child?
• · What do you do well as a parent/caretaker?
• · What do you need to learn as a parent/caretaker?
• · Do you like being a parent/caretaker?
• · What advice would you give someone who was thinking about becoming a parent/caretaker?

Questions for Caseworkers Assessing Risk

• · Have you visited the child’s home?
• · Were the physical premises reasonably clean and safe for children?
• · Was there adequate food in the house?
• · Did you see the child during the visit?
• · Did the child look healthy and clean?
• · When you visited, did you have the opportunity to speak with all the people living at the family’s residence?
• · From what you have observed, is there anyone in the household who may be a danger to the child?
• · Does the family appear to want the child?
• · Do the parents appear interested in the child?
• · Has there been a change in the child’s attendance at school or visibility in the community?
• · What advice would you give someone who was thinking about becoming a parent/caretaker?

If the child has returned home following placement:

• · Did the child want to return home?
• · Did the parent(s) try to stay in contact during placement?
• · Were the problems which caused the removal resolved? How do you know?
• · Did the plans made for the child’s return home address, medical, educational and financial needs, and living arrangements?
• · Do the plans appear to be working?