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Recognizing Child Abuse and Neglect:
Signs and Symptoms

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If you do suspect a child is being harmed, reporting your suspicions may protect the child and get help for the family.  Any concerned person can report suspicions of child abuse and neglect. Some people (typically certain types of professionals) are required by law to make a report of child maltreatment under specific circumstances-these are called mandatory reporters.

Professionals Required to Report Suspected Abuse (Mandatory Reporters)
Individuals designated as mandatory reporters typically have frequent contact with children. Such individuals may include:

  • Social workers

  • Teachers and other school personnel

  • Physicians and other health-care workers

  • Mental health professionals

  • Childcare providers

  • Medical examiners or coroners

  • Law enforcement officers

  • Court Appointed Guardians

For more information about where and how to file a report, contact your local child protective services agency or police department. An additional resource for information and referral is the National Child Abuse Hotline (800.4.A.CHILD)

Recognizing Child Abuse

The following signs may signal the presence of child abuse or neglect.

The Child:

  • Shows sudden changes in behavior or school performance

  • Has not received help for physical or medical problems brought to the parents' attention

  • Has learning problems (or difficulty concentrating) that cannot be attributed to specific physical or psychological causes

  • Is always watchful, as though preparing for something bad to happen

  • Lacks adult supervision

  • Is overly compliant, passive, or withdrawn

  • Comes to school or other activities early, stays late, and does not want to go home

The Parent:

  • Shows little concern for the child

  • Denies the existence of-or blames the child for-the child's problems in school or at home

  • Asks teachers or other caregivers to use harsh physical discipline if the child misbehaves

  • Sees the child as entirely bad, worthless, or burdensome

  • Demands a level of physical or academic performance the child cannot achieve

  • Looks primarily to the child for care, attention, and satisfaction of emotional needs

The Parent and Child:

  • Rarely touch or look at each other

  • Consider their relationship entirely negative

  • State that they do not like each other
     

Types of Abuse - signs

The following are some signs often associated with particular types of child abuse and neglect: physical abuse, neglect, sexual abuse, and emotional abuse. It is important to note, however, that these types of abuse are more typically found in combination than alone. A physically abused child, for example, is often emotionally abused as well, and a sexually abused child also may be neglected.

Signs of Physical Abuse

In more than half of the cases of child abuse treated in America, children sustain head, face and neck injuries. In a 10-year study of our nation's emergency rooms, child abuse accounted for more than 10 percent of all blunt trauma to patients younger than 5 years old. It was also found that abused children were mainly injured by battering (53%) and by shaking (10.3%). "The injuries most commonly are inflicted with blunt trauma with an instrument, eating utensils, hands, or fingers or by scalding liquids or caustic substances." Common dental injuries include cuts on the tongue, damaged soft and hard palate, fractured teeth, facial bone and jaw fractures, and burns. "Multiple injuries, injuries in different stages of healing, injuries inappropriate for the child's stage of development, or a discrepant history should arouse suspicion of abuse."

In an 10-year study of America's emergency departments, it was found that children injured by abuse sustain more severe injuries, utilize more medical services, and have worse outcomes than children with accidental injuries. "Children injured by child abuse were more likely to have retinal hemorrhages (27.8% vs 0.06%) than children with unintentional injuries... Abused children were more likely than unintentionally injured children to sustain intracranial injury (42.2% vs 14.1%) and thoracic (12.5% vs 4.5%) and abdominal (11.4% vs 6.8%) injuries; to sustain very severe injuries (22.6% vs 6.3%); and to be admitted to the intensive care unit (42.5% vs 26.9%). The mean length of stay for children who were abused was significantly longer (9.3 vs 3.8 days) and the survival to discharge from the hospital was significantly worse (87.3% vs 97.4%) than for those unintentionally injured. Among the survivors, children who were abused developed extensive functional limitations more frequently than those unintentionally injured (8.7% vs 2.7%)."

Consider the possibility of physical abuse when the child:

  • Has unexplained burns, bites, bruises, broken bones, or black eyes

  • Has fading bruises or other marks noticeable after an absence from school

  • Seems frightened of the parents and protests or cries when it is time to go home

  • Shrinks at the approach of adults

  • Reports injury by a parent or another adult caregiver
     

Consider the possibility of physical abuse when the parent or other adult caregiver:

  • Offers conflicting, unconvincing, or no explanation for the child's injury

  • Describes the child as "evil," or in some other very negative way

  • Uses harsh physical discipline with the child

  • Has a history of abuse as a child
     

Signs of Neglect

Consider the possibility of neglect when the child:

  • Is frequently absent from school

  • Begs or steals food or money

  • Lacks needed medical or dental care, immunizations, or glasses

  • Is consistently dirty and has severe body odor

  • Lacks sufficient clothing for the weather

  • Abuses alcohol or other drugs

  • States that there is no one at home to provide care
     

Consider the possibility of neglect when the parent or other adult caregiver:

  • Appears to be indifferent to the child

  • Seems apathetic or depressed

  • Behaves irrationally or in a bizarre manner

  • Is abusing alcohol or other drugs
     

Signs of Sexual Abuse

There are no medical signs in the vast majority of sexual abuse cases.

Several physical injuries are strong signs of sexual abuse. The oral cavity is a frequent site of sexual abuse in children. The presence of oral and perioral gonorrhea or syphilis in prepubescent children is a strong sign of sexual abuse. When gonorrhea or syphilis is diagnosed in a child, the case must be reported to public health authorities for investigation of the source and other contacts. Bite marks are lesions that may indicate sexual abuse. Gags applied to the mouth may leave bruises, scratching, or scarring at the corners of the mouth.

Consider the possibility of sexual abuse when the child:

  • Has difficulty walking or sitting

  • Suddenly refuses to change for gym or to participate in physical activities

  • Reports nightmares or bedwetting

  • Experiences a sudden change in appetite

  • Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior

  • Becomes pregnant or contracts a venereal disease, particularly if under age 14

  • Runs away

  • Reports sexual abuse by a parent or another adult caregiver
     

Consider the possibility of sexual abuse when the parent or other adult caregiver:

  • Is unduly protective of the child or severely limits the child's contact with other children, especially of the opposite sex

  • Is secretive and isolated

  • Is jealous or controlling with family members

  • Misuses alcohol or other drugs
     

Signs of Emotional Maltreatment

Consider the possibility of emotional maltreatment when the child:

  • Shows extremes in behavior, such as overly compliant or demanding behavior, extreme passivity, or aggression

  • Is either inappropriately adult (parenting other children, for example) or inappropriately infantile (frequently rocking or head-banging, for example)

  • Is delayed in physical or emotional development

  • Has attempted suicide

  • Reports a lack of attachment to the parent

Consider the possibility of emotional maltreatment when the parent or other adult caregiver:

  • Constantly blames, belittles, or berates the child

  • Is unconcerned about the child and refuses to consider offers of help for the child's problems

  • Overtly rejects the child

 

Sign and Symptoms - Expanded (click)
 

More Information:



With thanks to: Child Welfare Information Gateway

"Child Abuse: An Overview" was written by C. J. Newton, MA, Learning Specialist and published in the Find Counseling.com (formerly TherapistFinder.net) Mental Health Journal in April, 2001.
http://www.findcounseling.com/journal/child-abuse/physical-child-abuse.html

 

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