Preventing Abuse
in Your Childcare Center

Every year more than one million confirmed cases of child abuse occur in the U.S., and many more cases are never reported. Abuse is the second leading cause of death for children between the ages of six months and 13 years, following accidental death. Perhaps a quarter of the adults in the country experienced childhood sexual or physical abuse and the effects of abuse are long lasting. More than 90 percent of prison inmates were abused as children, and 70 percent of adults under psychiatric care report the same.

Child abuse has several forms and each state has its own legal definition, but the basic elements are as follows:

• Physical abuse is an intentional act against a child that produces physical harm.
• Neglect is the failure to provide food, shelter, a safe environment, education, and/or health care. In its most severe form, neglect results in physical harm. Neglect is the most common form of child abuse, and the deadliest.
• Sexual abuse includes a variety of acts involving contact and non-contact maltreatment. Contact sexual abuse is sexual contact with a child. Non-contact sexual abuse includes coercing the child to watch or pose for pornographic pictures or videos, to observe sexual intercourse, to perform sexual activities, or to witness sexual exhibitionism. Sexual abuse is more common than you may think; a quarter of adult women and a somewhat smaller number of men were sexually abused when they were children.
• Emotional abuse can include psychological or verbal abuse or any other action that causes mental harm. Lack of action, such as failure to show affection, also can lead to emotional abuse. Children who have experienced physical or sexual abuse are likely to suffer from emotional abuse as well, although this is generally hard to prove. Emotional abuse underlies all forms of abuse and neglect.

Almost all child abuse occurs in the home, with only two percent occurring in childcare programs or foster homes. Even though the risk of abuse in a childcare program is low statistically, parents and providers still must take precautions to assure that children in childcare programs are not abused.

Preventing Abuse in Childcare

Steps that providers should take to reduce the possibility of abuse occurring within the childcare setting are as follows:

• Complete thorough background checks on both prospective and current employees. While this process can be expensive and tedious, it is a significant safeguard against the possibility of child abuse occurring within the program. Many states require such checks by law. The National Resource Center for Health and Safety in Child Care provides links to the childcare licensing requirements for each state on its website.
• Forbid corporal punishment in the childcare setting, regardless of whether your state childcare licensing regulations allow it. Corporal punishment includes hitting, shaking, spanking, pinching, excessive exercise, and other measures that produce physical pain. Physical punishment does not improve the long-term behavior of children, and can cause harm. For example, shaking a baby for even a few seconds can injure the brain and cause lifelong damage or death. The childcare staff should be familiar with and skilled in other non-corporal methods of managing children's behavior, such as offering acceptable choices, redirection, logical consequences, and supervised and limited time-out.
• Educate yourself to recognize emotional abuse and take steps to avoid it. While the emotional abuse in conjunction with severe punishment or physical abuse may be obvious, other forms are harder to identify as abuse. Examples include adults who raise their voices frequently, use threats and fear to discipline children, belittle children, or reject them. Actions that are humiliating and painful can destroy relationships of trust and affection.
• Establish policies and procedures to discourage abuse, reassure parents and guardians, and protect innocent staff members. Provide a high level of visibility in your inside and outside areas as well as restrooms used by children to discourage secretive activities and also help protect staff members who may be falsely accused of abuse. When parents, guardians, and other adults can easily view the space, caregivers have more difficulty behaving in inappropriate ways. Maintain an "open-door" policy where parents and guardians are encouraged to visit the center or home at any time of the day. For center-based programs, design rooms so that there are windows to the hallways to keep classroom business from being too private. In addition, ensuring that the schedule has at least two adults in a room at all times also may help protect against abuse. Finally, if possible, provide video/security equipment to promote high visibility.
• Conduct daily visual health checks when each child arrives, and document any scratches, bruises, or other apparent injuries. Keep accurate records of any injuries suffered by children while under your care. The reports should include all relevant data, such as the types of injuries, parts of the body involved, the reported causes, who was in charge of the child at the time, and the results of the incident (treated on-site or referred to physician or hospital, notification of parents, etc.) A thorough and reliable system of record keeping will tend to protect the center from accusations of mistreatment and demonstrate the unlikeliness of abuse occurring in the facility.

Reporting Suspected Abuse

In addition to ensuring that the childcare center or home is free from child abuse, childcare providers must also be alert to the possibility of abuse occurring outside the childcare environment. Every child caregiver should be aware of and watchful for signs of child abuse and should participate in training on how to recognize and report suspected abuse. Every childcare program should have a written plan for the reporting of any event that threatens to the health, safety, or welfare of children, including child abuse. Appropriate reporting forms should be readily available in all child care centers and homes.

Although laws vary from state to state, the person reporting the suspected abuse generally must only have a "reasonable cause to believe, or to suspect, that abuse has occurred." The suspected maltreatment includes neglect, physical abuse, and sexual abuse. The responsibility of proving that abuse occurred lies with the investigative agency.

In addition, while states encourage all of their citizens to report suspected cases of child abuse, certain adults, including physicians, nurses, teachers, dentists, social workers, and others are required to make such reports. There are legal penalties, including fines and even possible imprisonment, if these people fail to report suspected abuse. In most states, child caregivers also are required to make such reports. The reporting process and the state law should be available in written form and posted in child care facilities and homes. Parents also must be made aware of this requirement.

Any caregiver who makes a report of suspected child abuse must be immune from retaliation or disciplinary action, including firing. States have laws that protect reporters of abuse from retaliation by the people who were reported as possible abusers.

Donald Palmer, MD, FAAP
American Academy of Pediatrics, Committee of Early Childhood, Adoption, and Dependent Care
and
Connie Jo Smith, EdD
Early Childhood Education Specialist, Training and Technical Assistance Services, Western Kentucky University

RESOURCES

To report suspected child abuse, call the Childhelp USA National Child Abuse Hotline at 800-4-A-CHILD (800-422-4453; TDD 800-2-A-CHILD) and they will provide state information and assist with the report process.

American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098; 888-227-1770; www.aap.org

The Center for Effective Discipline, 155 West Main St., Suite #1603, Columbus, OH. 43215; 614-221-8829; www.stophitting.com

Child Welfare Information Gateway, Children's Bureau/ACYF, 1250 Maryland Ave., SW, 8th Floor, Washington, DC 20024; 800-394-3366; www.childwelfare.gov

Prevent Child Abuse America, 200 S. Michigan Ave., 17th Fl., Chicago, IL 60604-2404;
312-663-3520; www.preventchildabuse.org

Safe Child Program, PO Box 6304, Denver, Colorado 80206; 800-320-1717; www.safechild.org

INTERNET RESOURCES

Project No Spank, nospank.net

The No Spanking Page, www.neverhitachild.org

National Resource Center for Health and Safety in Child Care, nrc.uchsc.edu

A sample injury reporting form is available at www.childhealthonline.org

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