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Let's take a moment to talk about a very serious topic called 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 report such abuse or neglect. First though, let's cover a little bit of background about this subject. According to the statistics covered by the United States Department of Health and Human Services, Administration for Children & Families, an estimated 679,000 children were victims of abuse and neglect and of those, over 1,500 children died from abuse and neglect just in 2013. Of these children, 80% suffered from neglect; 18% suffered a physical form of abuse; and 9% were victims of sexual abuse. As you can clearly see, this is a problem that is serious and far too common. My hope is that this training will give you the knowledge to recognize true abuse and neglect, and help you protect the innocent. Now, depending on your state laws, you may have a legal requirement to report suspected abuse as a person called a 'mandated reporter.' A mandated reporter is a person who is legally required to ensure a report is made to the proper authorities when abuse is observed or suspected. Specific details vary across states and jurisdictions so make sure you know your particular details. Abuse that must be reported typically includes that which can be categorized as neglect, physical, or sexual in nature. Mandated reporters may be paid staff or volunteers, but who have assumed full or even limited responsibility for the care of a child. This often includes: teachers, daycare providers, EMS personnel, coaches, camp staff, and other professionals. Unfortunately, abuse can occur anywhere, some examples include: childcare centers, schools, religious institutions, recreational and athletic programs, camps, residential facilities and even at home. The most predominant type of abuse is neglect. Neglect is something that means, 'despite available resources, the parent or legal caregiver fails to provide adequate food, clothing, shelter, and supervision and may not seek appropriate medical attention for illness or injury. This can happen for a number of reasons, but may specifically may include a family crisis, or a job loss, a serious illness to a caregiver. A divorce or separation of parents may cause a chaotic household with no structure or routines, or the home may seem to have little space for the child. Indicators of neglect may include: a child who looks undernourished and hungry. These children might be beggars for food because of this persistent hunger. The child may be lethargic, like they're not getting enough sleep due to disrupted schedules. -They have noticeably poor hygiene. Maybe they're inappropriately dressed for the weather. The child may have injuries that can be attributed to a lack of supervision, including those associated from being harmed by other people. The trigger that makes them suspect of abuse is that they say they have frequent 'accidents and injuries'. Along with these injuries, they have a poor ability to relate to others and have poor self-esteem. Maybe they have attachment difficulties or other social problems like the inability to say no to inappropriate requests. These are all different ways we can suspect neglect and recognize that there may be a problem. Unlike neglect, physical abuse is any act that, regardless of intent, results in a non-accidental, physical injury to a child. It can happen as a result of a parent becoming frustrated or angry and strikes, shakes or even throws a child. Physical abuse may be an intentional, deliberate assault, such as burning, biting or cutting, the child. It's vital to remember that all children get bumps, bruises and cuts, 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 accidents. In all cases, consider the context. Take into account the child's explanation of the injury, the child's age and overall behavior that you notice in the child. The following is a closer look at specific signs of physical abuse. Questionable bruises and welts or other injuries on the face, around the lips and mouth. Cuts and bruises on the torso, back, buttocks and thighs, in various stages of healing. In other words, the bruises might be different colors like some red and purple while others are yellowish-green. The bruises reflect the shape of the object used to inflict the injury, like an electric cord or belt buckle. Look for questionable burns, like cigarette burns, especially on the soles of the feet, palms of the hands, the back or even the buttocks of the children. You may see signs of something we call immersion burns. This can be 'socklike' burns where we've seen they've put the baby or child into hot water. Donut shaped burns on the buttocks or genitalia or burn patterns that are like electric stove burners, where they're round and circular or look like the surface of an iron. Rope burns on arms and legs, neck or torso. Look for fractures to the skull, nose, face, and black eyes in various stages of healing. These all could indicate signs of physical abuse. Now let's look at behavioral indicators. Some behavioral indications might be that the child is uncomfortable with physical contact, being weary of adults and being apprehensive when other children cry. They may show emotional extremes like being overly aggressive or extremely withdrawn. In some cases the child may be frightened of the parents and afraid to go home. They may arrive to school very early or stay very late, again, possible indicators that the child is avoiding the need to go home. Look for a track record where the child has made repetitive attempts to run away from home. Be alert to reports that the child is being hurt by a parent or someone at home or in their community and maybe complaining of body or limb soreness or moving uncomfortably. Maybe the child is wearing clothing inappropriate to the weather, like big loose or bulky shirts and pants in order to cover the body or wounds. Additionally, they may be reluctant to change clothes in public or for gym activities. This again being an attempt to hide injuries or bruises as a result of abuse. So, how do you tell the difference between normal discipline and abuse? It's important that there be some objective guidelines between corporal punishment and abuse. Corporal punishment, which is allowed in some areas of the United States, such as spanking, may be used as 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, where the goal is not to stop inappropriate behavior but to inflict pain and is usually the result of anger, loss of control and frustration. There's a difference between accidents and purposeful injury. But how does one 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 the same type of injury happens frequently it's less likely to be an accident unless it's in a location that is socially acceptable for the appropriate age and activity level of the child. If multiple injuries are present, especially in different stages of healing, it's less likely to be an accident unless the child is in a full-contact sport. If a series of injuries appear in a pattern or resemble an object like an electrical cord or wooden spoon, it's very suspicious and may have been inflicted by abuse. If a child's caregiver gives an explanation for injuries that is inconsistent with the facts, then the injury may be 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 thing when he picked Steve up from school, and Steve was glad to see his father. 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 back 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. In this situation, you should suspect abuse. Susie's secrecy, her fear of her mother being called, the bruises on her upper arms and back, the specific injury pattern, and the evidence of the various stages of healing are all multiple indicators of possible abuse. Remember, reporting suspected abuse is helping to protect those who are being abused. Now 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 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, and child pornography. Indicators of child sexual abuse include 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- like feelings like "It's my fault." They may also indicate shame. They may have serious depression or maybe depression in general, anxiety, or mood swings. One the strongest indicators of sexual abuse is 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 truly abuse, a good justice will find that out. So how should you respond to the abuse? Abusers often tell children that bad things will happen if they tell others about it or that it's a secret that is not to be shared. Because of this fear, children are 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. There are different forms of disclosure. 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 and 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. It's important not to 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. Just that you 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 report. 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 of a true rescuer for a child who may be in serious danger.
Child abuse and neglect is a very serious topic and not one that anyone enjoys reading about. But it's vitally important, especially for those of you working in an industry mandated to report any suspicions of abuse and neglect.
Pro Tip #1: A mandated reporter is a person required by law to report reasonable suspicions of abuse and neglect, such as teachers, day care providers, EMS personnel, coaches, camp staff, and other professionals.
According to statistics from the U.S. Department of Health and Human Services, 679,000 children were the victims of abuse and neglect in 2013, and in that same year 1500 children died as a result.
Of those 679,000 child abuse victims, 80 percent suffered from neglect, 18 percent from physical abuse, and nine percent from sexual abuse. These numbers indicate a serious problem that has become far too common.
In this lesson, you'll learn the key indicators for recognizing abuse and neglect in children.
How to Recognize Abuse and Neglect
Child abuse is a prevalent problem that can occur anywhere, including:
- Child day care centers
- Schools
- Religious institutions
- Recreational and athletic facilities
- Camps
- Residential facilities
- The child's home
What is Neglect?
Neglect by a parent or primary caregiver is the most prominent type of child abuse. It's defined as a failure to provide adequate food, clothing, shelter, supervision, or medical attention.
Indications of neglect include a child who …
- Looks undernourished
- Appears lethargic and tired
- Has poor hygiene
- Is inappropriately dressed for the weather
- Sustains injuries due to lack of supervision
- Has poor self esteem
- Has trouble relating to others
What is Physical Abuse?
Physical abuse is defined as non-accidental physical injury to a child – by striking, shaking, throwing, burning, biting, cutting, etc.
Pro Tip #2: All kids get bumps and bruises from time to time, particularly those that are more adventurous or into sports. It's important for you to understand when those injuries occur due to abuse versus regular childhood mishaps.
Physical indications of physical abuse include:
- Questionable bruises, cuts, and welts
- Cuts and bruises to the torso, back, buttocks, and thighs
- Injuries in various stages of healing, indicating abuse over time
- Bruises shaped like the objects that were used – belt buckle, electrical cord, etc.
- Burns like those from cigarettes, particularly on the soles of the feet, palms of the hands, back, and buttocks
- Immersion burns like you would get from scalding hot water
- Burns in the shape of irons, stove top burners, etc.
- Rope burns, especially on the arms, legs, neck, and torso
- Fractures
- Black eyes
Behavioral indications of physical abuse include when the child is …
- Uncomfortable with physical contact
- Wary of adults
- Apprehensive when other children cry
- Emotionally unstable, aggressive one moment, withdrawn the next
- Frightened of own parents
- Afraid to go home – perpetually arrives to school early and stays late
- Trying to hide the injuries – reluctant to change in front of others, wears clothes to conceal injuries
Pro Tip #3: Does the child have a history of running away from home? A child with a long history of repeated attempts to run away can also be cause for concern, particularly when combined with any other indicators of abuse.
What is the Difference Between Discipline and Abuse?
This comes up occasionally as corporal punishment (spankings and such) are still allowed in certain areas of the U.S.
What defines discipline? It is a learning process to teach appropriate behavior.
What defines abuse? Inflicting pain; that's it. There's no learning objective. It's usually the result of anger, frustration, and loss of control.
How Can You Tell the Difference Between Abuse and Accidental Injury?
As mentioned earlier, kids get hurt sometimes; it's part of being a kid. But sometimes it's much more than that. And while injuries from abuse and accident can look similar, there are some important differences you should know about.
- When it comes to accidental cuts and bruises, the areas most affected are on the outside of the body, like knees and elbows. However, with abuse, the common areas are the stomach and buttocks.
- As frequency goes up, the chances of accidental injury go down. Look for injuries, especially bruises, in different stages of healing, as in different colors. This may become a moot point if the child is a tackle football player.
- Do the injuries resemble an object – like a wooden spoon or electrical cord – or appear in a pattern. These are pretty suspicious circumstances and most likely from an adult.
- Has the parent or primary caregiver provided the same story as the child?
- Does their relationship appear normal, or does the child appear afraid of the parent or caregiver?
What is Sexual Abuse?
Sexual abuse is a complex type of child abuse and is defined as any illegal sexual act upon a child including incest, rape, indecent exposure, fondling, child prostitution, and child pornography.
There are often no visible signs to accompany sexual abuse, or else they're too subtle to notice or attributed to something else. Add to that how the adult abuser is usually able to manipulate the child into silence and uncovering sexual abuse becomes even more difficult.
For the child, this sort of manipulation is beyond their scope of understanding. It's emotionally confusing. And it results in a wide range of emotional responses.
Indications of child sexual abuse include when the child has …
- Inappropriate knowledge of sex
- Sexually explicit drawings
- An unexplained fear of a person or place or is attempting to avoid a familiar adult
- Nightmares or sleep disruptions
- Become withdrawn
- Guilt and shame issues
- Symptoms of depression and anxiety
- Wild mood swings
Pro Tip #4: The best indicator is when a child says so. Take statements seriously. Resolve doubt in favor of the child. And err on the side of protection.
Three Ways Sexually Abused Children Share Their Experience
Because of the secrecy involved or the fact they're told something bad will happen, children who are sexually abused rarely tell anyone. They may, however, provide a mix of clues if you're paying attention.
Here are three examples of things a child suffering from sexual abuse may say.
- Indirectly – My babysitter keeps bothering me.
- Disguised – What would happen if a girl was being touched in a bad way and she told someone?
- With strings attached – I'm having a problem, but if I tell you about it, you have to promise not to tell anyone.
When dealing with a child who has been sexually abused, listen, remain calm, and encourage the child to talk, but never press them. Be honest. Tell them the truth, which is that you may need to tell someone in order to get them the help they need.
If you ever suspect abuse or neglect, report your suspicion to local law enforcement or child protective services in your area. And if you're a mandated reporter, you have a legal responsibility to report.