The Identification and Reporting of Child Abuse and Maltreatment Course For Mandated Reporters

Indicators for Abuse and Maltreatment

Characteristics of Abusive Parents or Caretakers

What are the Signs and Symptoms in Children?

The following sections list the indicators for child abuse and maltreatment. It is important to note that:

• Indicators serve as clues rather than conclusive proof. These indicators may exist in situations where a child is not suspected to be abused or maltreated. However, they are useful to remember when dealing with the parent/caregiver or child.
• Clues rarely appear as single entities. Typically, several clues will appear regarding the child and his/her family.
• Except for the obvious cases where there is direct disclosure, or a blatant indicator, single clues should be treated as "flags" which indicate that the professional needs to look further, and look more closely, carefully, and methodically.

Characteristics of Abusive Parents or Caretakers

Parent/Caretaker History

>>Parent abused or neglected as child;

>> Lack of friendships or emotional support

• isolated from supports such as friends, relatives, neighbors, community groups
• lack of self-esteem, feelings of worthlessness;

>> Relationship problems of parents or possibly grandparents

• Including spouse abuse;

>> Physical or mental health problems, irrational behaviors, difficulty controlling anger or stress;

>> Life crises

• Financial debt, unemployment/underemployment, housing problems, etc.;

>> Alcohol or substance abuse. This includes grandparents

>> Adolescent parents.

Parent-Child History

>> Parent's unrealistic expectations of child's physical and emotional needs

• Children with mental or developmental disabilities are particularly vulnerable;

>> Parent's unrealistic expectations of child to meet parent's emotional needs whereby parent is looking for child to be the caregiver.

• Children viewed as "miniature adults";

>> Absence of nurturing child-rearing skills

• violence/corporal punishment is accepted as unquestioned child-rearing practice within the parent's culture
• violence is accepted as a normal means of personal interaction;

>> Delay or failure in seeking health care for child's injury, illness, routine checkups, immunization, etc;

>> Parent views child as bad, evil, or different.

Environmental

>> Lack of social support

• inability to ask for and receive the kind of help and support parents need for themselves and their children
• social contact is avoided; no one is trusted

>> Homelessness

What are the Signs and Symptoms in Children?

Physical Abuse

Physical Indicators
Special attention should be paid to injuries that are unexplained or are inconsistent with the parent or caretaker's explanation as well as the developmental stage of the child.

>> Bruises, welts, and bite marks:

• on face, lips, mouth, neck, wrists, and ankles
• on torso, back, buttocks, and thighs
• injuries to both eyes or cheeks
  • These injuries are always of suspicious origin because only one side of face is usually injured as the result of an accident
• clustered, forming regular patterns reflecting shape of article used to inflict (electric cord, belt buckle)
• "grab-marks" on arms or shoulders
• on several different surface areas
• evidence of human bite
  • A human bite compresses the flesh while an animal bite tears the flesh and has a narrower teeth imprint
• in various stages of healing
• regularly appear after an absence, weekend, or a vacation

>> Lacerations or abrasions:

• To mouth, lips, gums, eyes
• To external genitalia
• On backs or arms, legs or torso

>> Burns:

• cigar, cigarette burns, especially on soles, palms, back, or buttocks
• immersion burns by scalding water (sock-like, glove-like, doughnut-shaped on buttocks or genitalia - "dunking syndrome")
• patterned like electric burner, iron, curling iron, etc.
• rope burns on arms, legs, neck, or torso

>> Fractures:

• to skull, nose, facial structure
• skeletal trauma accompanied by other injuries, such as dislocations
• multiple or spiral fractures
• in various stages of healing
• fractures "accidentally" discovered in course of an exam

>> Head injuries:

• absence of hair and/or hemorrhaging beneath the scalp due to vigorous hair pulling
• subdural hematoma is a hemorrhage beneath the outer covering of the brain, due to severe hitting or shaking
• retinal hemorrhage or detachment, due to shaking
• "whiplash shaken infant syndrome"
• eye injury
• jaw and nasal fractures
• tooth or frenulum injury

>> Symptoms suggestive of parentally-induced or fabricated illnesses:

• sometimes known as Munchausen Syndrome by Proxy (MSP) An example of this might be repeatedly causing a child to ingest quantities of laxatives sufficient to cause diarrhea, dehydration, and hospitalization.

Behavioral Indicators

>> Wary of contacts with parents or other adults

>> Apprehensive when other children

>> Behavioral extremes like aggressiveness, withdrawal, or extreme mood changes

>> Afraid to go home; repeated incidents of running away

>> Reports injury by parents as being deserving. The child blames self-saying, "I was bad and I was punished."

>> Habit disorders

• self-injurious behaviors
• psychoneurotic reactions (obsessions, phobias, compulsions, hypochondria)

>> May wear long sleeves or other concealing clothing to hide physical indicators of abuse that are often inappropriate for the season

>> Manifestations of low self-esteem

>> Suicide attempts

>> Report of the injury does not match type of injury. A child may say he/she fell yet the bruise matches that of grab marks

Maltreatment and Neglect

Physical Indicators

>> Failure to thrive (physically or emotionally)

>> Positive indicator of toxicology, especially 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

>> Begging, stealing food

>> Extended stays at school like early arrival or late departure

>> Constant fatigue, listlessness or falling asleep in class

>> Alcohol or drug abuse

>> Delinquency (e.g., thefts)

>> States there is no caretaker

>> Runaway behavior

>> Habit disorders like sucking, biting, and rocking

>> Conduct disorders as in antisocial, destructive, etc.

>> Neurotic traits like sleep disorders or inhibition to play

>> Psychoneurotic reactions (hysteria, obsession compulsion, phobias, hypochondria)

>> Behavior extremes:

• compliant, passive
• aggressive, demanding, bullying

>> Overly adaptive behavior:

• inappropriately adult
• inappropriately infant

>> Lags in mental and/or emotional development

>> Attempted suicide

Sexual Abuse

Sexual abuse does not usually present obvious physical evidence or indicators, thus making it difficult to detect. Also the child victim of sexual abuse has legitimate fears about coming forth, even to someone they trust.

The vast majority of child molesters are family members or friends of the child or the family making disclosure of the abuse very difficult for the child. Victims of child sexual abuse experience the fear of betraying a loved one or losing the affection of the perpetrator or even the non-abusing parent if they disclose the abuse.

The impact of what this disclosure could do to the family is overpowering for a child. Marriages end, families break up, children are removed from the home, and a parent is incarcerated. Child victims fear the overwhelming anticipated shame and guilt that such disclosure will cause, and they fear that family members and other significant people in their lives will blame them for the abuse. They also fear the common threats of being hurt or even killed if they disclose the abuse.

Even after disclosing sexual abuse, a child may retract the disclosure as the family system begins to place pressure. For these and other reasons, sexually abused children often decide to live in quiet and devastating isolation with their "secret" rather than risk the realization of their fears.

It is very important to keep in mind that the overwhelming majority of child sexual abuse occurs within the child's immediate or extended family. Most perpetrators of child sexual abuse are known to the child before the abuse. They are usually trusted members who have easy physical access to their child victims, not necessarily the stereotypical strangers in raincoats who wait for children on street corners with lures of candy or money.

Child sexual abuse is not a problem uniquely found in only certain geographic areas or among people of certain economic conditions, races, or occupations. 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.

Physical Indicators

>> Difficulty in walking or sitting

>> Torn, stained, or bloody underclothing

>> Pain or itching in genital area

>> Bruises or bleeding in the 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 the early adolescent years

>> 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

>> Reports sexual assault by caretaker

>> Prostitution

>> Forcing sexual acts on other children

>> Extreme fear of being touched

• unwilling to submit to physical examination

>> Truancy

>> Self-injurious behaviors

• suicide attempts

>> Manifestations of low self-esteem, general fearfulness

>> Unnatural Interest in sex