Recognizing and
Reporting Abuse

Childcare providers can play an important role in recognizing possible signs of child maltreatment, but you must know what to look for. Understanding the types of maltreatment (such as physical abuse, sexual abuse, and neglect), considering all possible scenarios, and determining the proper steps to help the child are key to making the best decisions and protecting everyone involved.

Reading the Signs

Neglect accounts for 60 percent of reports of child maltreatment. In many cases of physical or sexual abuse, the child also suffers from neglect. Outward signs of neglect may include:

• Slovenly or careless dressing.
• Clothes that are dirty or in poor repair.
• Hair that is always in need of washing.
• Fingernails that are long and dirty.
• Sores and skin conditions that are neglected or improperly treated.
• Clothing that may be inappropriate for the weather.
• Signs of hunger, like begging for food or hoarding it.

A more subtle sign, particularly in infants and young children, is "failure to thrive," meaning not only inadequate growth in height and weight (in the absence of illness), but in socialization and other normal development as well. This is usually a result of neglect.

A history of delaying care or ignoring an obvious need for medical attention is another warning flag for neglect. Similarly, a history of having gone to several doctors, or to various emergency rooms, is consistent with abuse and neglect.

Signs of physical abuse are more easily recognized, yet they are reported less frequently than neglect. Signs of physical abuse may include the following:

• Bruises are suggestive of abuse, especially when they are on the face or if the child has multiple bruises in various stages of healing. Bruises go through a progression of colors as they age, from reddish, to dark purple or reddish brown, to brown or yellowish brown. Thin, bruise-like lines are suggestive of the finger prints of a heavy slap. Hairbrushes, belts, and other objects also leave suggestive and unique prints.
• Immersion burns leave telltale signs characterized by sharp and often straight borders, whereas a child burned by scalding water accidentally will splash violently, leaving small burns in the nearby areas.
• Burns that are deep, perfectly circular, or of cigarette size may indicate severe abuse or torture. Children who accidentally touch a lighted cigarette tend to have burns that are not so deep and have blurred margins.
• Multiple broken bones (sometimes in differing stages of healing) are an important warning sign of serious abuse. Broken ribs or a skull fracture also are common manifestations of abuse.

Childcare providers should be wary when the report by the parent or child of an injury seems inconsistent with the nature of the injury. Babies typically do not break their legs by being caught between the slats of their playpen. Small children rarely fracture their skulls by falling off of sofas or laps. Listen for stories that change over time or that differ when told by the parent versus the child.

Sexual abuse is reported only half as often as physical abuse. Signs of possible sexual abuse include:

• Injury to the genitalia, with bruises, bleeding, itching, and pain
• Excessive concern with the child's own or another child's genitalia
• Abnormal masturbatory activity

Which Children Get Abused?

Abuse is not limited to any particular groups of children or families. However, there are established risk factors that indicate the potential for abuse, conditions which, if present, should raise awareness. Children with special needs or abilities, who were born prematurely, have repeated or chronic illnesses, or have physical disabilities are at increased risk of abuse. Children with hearing impairments or blindness also are at a greater risk of abuse, as are children resulting from unplanned pregnancies. Children with behavioral or emotional problems or mental illness are frequent targets for abuse. Children who are loud and aggressive, with colic in infancy and boisterousness in early childhood followed by hyperactivity, also may become victims of abuse.

Which Adults Abuse Children?

A variety of factors may lead a parent or caregiver to abuse or neglect the child. Abusers may have mental or emotional disorders, such as depression, tempers, mood swings, and low self-esteem. Undeveloped parenting skills, social isolation, or lack of support in raising children from family, friends and others can reinforce their negative feelings and further their frustration, and also can lead them to develop unrealistic expectations of their children. Home environments where substance abuse or spousal/partner abuse occur are not proper environments for children, and children in such homes are at higher risk to be abused or neglected.

Socioeconomic impoverishment is both the background and the trigger in many cases. A caregiver with an unstable or low-paying job and economic fragility is particularly susceptible to stress and the mistake of abusing her children. The loss of a job, foreclosure on the house, or a lien executed by a debtor may push the parent "over the edge."

Taking the Signs in Context

A key factor in learning to recognize child abuse concerns taking the information in context. For example, caregivers need to learn how to distinguish between signs of poverty and signs of neglect. Clothing that is inappropriate for the weather may be a sign of neglect--and if so should be reported--or it may be a sign of extreme poverty. The childcare provider should offer a friendly suggestion to the parents that the child wear more appropriate clothing and assess the response. It may be necessary to offer a referral to a clothing bank or help find a donation of clothing. If the suggestions are well taken, and the child returns properly dressed, the situation should not be reported.

When a child shows up with tangled, dirty hair, it could be because the parent overslept and had to rush for fear of losing a job. The last thing this parent needs is to be accused of child neglect. Again, offer a friendly suggestion to the parents about hygiene and see if any change occurs. But if the child arrives routinely with unkempt hair, reporting a potential case of neglect should be considered. Conversely, sympathy for the parent's hardships or personal problems should not prevent the caregiver from acting if the child is being abused or neglected. It can be a tough call!

Childcare providers should observe carefully, keep accurate records, and look for patterns so that they are not overreacting overeagerly in applying their skills in recognizing signs of abuse and neglect.

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

RESOURCES

Child Help USA, 15757 N. 78th St., Scottsdale, Arizona 85260; 800-4-A-CHILD; www.childhelpusa.org

National Committee for the Prevention of Child Abuse, PO Box 2866, Chicago IL 60690-9959; 312-663-3529; www.preventchildabuse.org

National Clearinghouse on Child Abuse and Neglect, 330 C Street, SW, Washington, DC 20447; 800-394-3366; www.calib.com/nccanch

INTERNET RESOURCES

International Child Abuse Network, www.yesican.org

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