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How do you know if you were sexually abused as a child? If you were abused, how do you know if it’s still impacting you today? How do I know if I need healing? Why do I struggle with sexual intimacy? What is child abuse? How can child abuse happen? What is Child Abuse and Neglect? What Are the Major Types of Child Abuse and Neglect? What do I need to know about child abuse? What are the signs or symptoms of child abuse and neglect? At what age can a child legally be left home alone? What can I do if I suspect child abuse or neglect? How do I report child abuse or neglect? Can I make an anonymous report of abuse? How many children are abused and neglected each year? Who typically abuses children? How many children die each year due to abuse or neglect? What kind of people abuse children? Are people who abuse children also prior victims of abuse themselves? Does counseling help perpetrators of abuse? What risk factors increase a child's likelihood of being physically abused? Does counseling help perpetrators of abuse? What risk factors increase a child's likelihood of being physically abused? What should I do if I witness child abuse in a public place? I've heard that babies get brain injury if they are shaken. How can I avoid injuring my baby's brain? How can I prevent child sexual abuse? What should I do if I witness child abuse in a public place? I've heard that babies get brain injury if they are shaken. How can I avoid injuring my baby's brain? How can I tell if my child has been physically abused? What should I do if I suspect my child has been physically abused? My child bruises easily. Will I be accused of child abuse? When is masturbation abnormal? How can I tell if my child has been sexually abused? Do children make up stories of abuse that never occurred? When I bring my child to the emergency room for an injury, I'm afraid I'll be accused of child abuse. What should i say to the doctors and nurses when I bring my child in with an injury? My daughter (or son) has genital (or rectal) warts (or herpes). Does this mean he/she was sexually abused? My child's doctor says her vaginal examination was normal, but she says she was penetrated. How can this be so? Can bicycle injuries or other straddle-type injuries break my daughter's hymen? Does counseling help child abuse victims? Why do doctors order x-rays when testing for physical abuse? Should I let them take the x-rays? Isn't all that radiation bad? Will my child ever get over the abuse? Can a doctor make a determination of sexual abuse after a physical examination? I don't want my daughter upset by the examination. Can she be sedated? How painful is the physical examination for sexual abuse? Is it like an adult pelvic examination? What types of sexual abuse are consistent with normal examinations? Can the number of abuse episodes and when they occurred be determined by exam? Why does one examiner's report differ from another's? Whom do I call to report abuse? What happens after I report abuse? What should I do if I think my child has been sexually abused? Will my child have to testify in court? What is a mandated reporter? What happens after I make a report? What is the scope of the child abuse problem? What age child is abused? Are girls more often abused than boys? Is the pattern of abuse different for girls and boys? What is known about the perpetrators of child abuse? Is there an association between poverty and child abuse? Who abuses children? What is child abuse? What does the term child neglect include? What actions are viewed as physical child abuse? What constitutes emotional child abuse? What is sexual child abuse? What causes child abuse deaths? What factors predispose a person to child abuse? How is alleged child abuse evaluated? How is child abuse treated? How can child abuse be prevented? What more can be done to prevent child neglect? Are people who were abused as children more likely to become criminals later in life? * What is the scope of the child abuse problem? * What age child is abused? * Are girls more often abused than boys? * Is the pattern of abuse different for girls and boys? * What is known about the perpetrators of child abuse? * Is there an association between poverty and child abuse? * Who abuses children? * What is child abuse? * What does the term child neglect include? * What actions are viewed as physical child abuse? * What constitutes emotional child abuse? * What is sexual child abuse? * What causes child abuse deaths? * What factors predispose a person to child abuse? * How is alleged child abuse evaluated? * How is child abuse treated? * How can child abuse be prevented? * What more can be done to prevent child neglect? * Are people who were abused as children more likely to become criminals later in life? * Child Abuse At A Glance What is child abuse? Child abuse happens in many different ways, but the result is the same- serious physical or emotional harm. Physical or sexual abuse may be the most striking types of abuse, since they often unfortunately leave physical evidence behind. However, emotional abuse and neglect are serious types of child abuse that are often more subtle and difficult to spot. Child neglect is the most common type of child abuse. How can child abuse happen? You can make a difference One of the most painful effects of child abuse is its tendency to repeat itself. One of every three abused or neglected children will grow up to become an abusive parent. You may be reluctant to interfere in someoneÂ’s family, but you can make a huge difference in a childÂ’s life if you do. The earlier abused children get help, the greater chance they have to heal from their abuse and not perpetuate the cycle. Physical child abuse: Warning signs and how to help Many physically abusive parents and caregivers insist that their actions are simply forms of discipline, ways to make children learn to behave. But thereÂ’s a big difference between giving an unmanageable child a swat on the backside and twisting the childÂ’s arm until it breaks. Physical abuse can include striking a child with the hand, fist, or foot or with an object, burning, shaking, pushing, or throwing a child; pinching or biting the child, pulling a child by the hair or cutting off a childÂ’s air. Another form of child abuse involving babies is shaken baby syndrome, in which a frustrated caregiver shakes a baby roughly to make the baby stop crying, causing brain damage that often leads to severe neurological problems and even death. Warning signs of physical abuse Physical signs. Sometimes physical abuse has clear warning signs, such as unexplained bruises, welts, or cuts. While all children will take a tumble now and then, look for age-inappropriate injuries, injuries that appear to have a pattern such as marks from a hand or belt, or a pattern of severe injuries. Behavioral signs. Other times, signs of physical abuse may be more subtle. The child may be fearful, shy away from touch or appear to be afraid to go home. A childÂ’s clothing may be inappropriate for the weather, such as heavy, long sleeved pants and shirts on hot days. Caregiver signs. Physically abusive caregivers may display anger management issues and excessive need for control. Their explanation of the injury might not ring true, or may be different from an older childÂ’s description of the injury. Q) What is Child Abuse and Neglect? Q) What Are the Major Types of Child Abuse and Neglect? Reporting Suspected Child Abuse Sample Report of Suspected Child Abuse and Neglect Abuser Administrator Principal Teacher Staff Others |
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Nutrition Parenting Advice Vaccine What do I need to know about child abuse? Child abuse is common. The news is so full of reports about child mistreatment that you can't help but wonder how safe your child really is. Although it's a mistake to become overprotective and make your child fearful, it is important to recognize the actual risks and familiarize yourself with the signs of abuse. More than 2.5 million cases of child abuse and neglect are reported each year. Of these, thirty-five of one hundred involve physical abuse, fifteen of one hundred involve sexual abuse, and fifty of one hundred involve neglect. Studies show that one in four girls and one in eight boys will be sexually abused before they are eighteen years old. About one in twenty children are physically abused each year. Where abuse occurs Most child abuse occurs within the family, often by parents or relatives who themselves were abused as children. Neglect and mistreatment of children is also more common in families living in poverty and among parents who are teenagers or are drug or alcohol abusers. Although there has been a recent increase in child abuse outside the home, it is still true that most often children are abused by a caregiver or someone they know, not a stranger. Types of abuse Sexual abuse is any sexual activity that a child cannot comprehend or consent to. It includes acts such as fondling, oral-genital contact, and genital and anal intercourse, as well as exhibitionism, voyeurism, and exposure to pornography. Physical abuse involves injuring a child's body. This could include bruising, burns, bone injury, head injury, and injury to an internal organ. Because a bruise indicates that body tissue has been damaged and blood vessels have broken, any discipline method that leaves bruises is by definition physical abuse. Child neglect can include physical neglect (withholding food, clothing, shelter, or other physical necessities), emotional neglect (withholding love, comfort, or affection), or medical neglect (withholding needed medical care). Psychological abuse results from all of the above, but also can be associated with verbal abuse. Signs and symptoms It's not always easy to recognize when a child has been abused. Children who have been mistreated are often afraid to tell anyone, because they think they will be blamed or that no one will believe them, or because the person who abused them is someone they love very much. Parents also tend to overlook symptoms, because they don't want to face the truth. This is a serious mistake. A child who has been abused needs special support and treatment as early as possible. The longer he continues to be abused or is left to deal with the situation on his own, the less likely he is to make a full recovery. The best way to check for signs of abuse is to be alert to any unexplainable changes in your child's body or behavior. Don't conduct a formal "examination" unless you have reason for suspicion, as this may make the child fearful, but do look further if you notice any of the following: Physical abuse * Any injury (bruise, burn, fracture, abdominal or head injury) that cannot be explained Sexual abuse * Fearful behavior (nightmares, depression, unusual fears) * Abdominal pain, bedwetting (especially if the child had already been toilet trained), genital pain or bleeding, sexually transmitted disease * Attempts to run away * Extreme sexual behavior that seems inappropriate for the child's age Psychological maltreatment * Sudden change in self-confidence * Headaches or stomachaches with no medical cause * Abnormal fears, increased nightmares * Attempts to run away * School failure Emotional neglect * Failure to gain weight (especially in infants) * Desperately affectionate behavior * Voracious appetite and stealing of food Getting help If you suspect your child has been abused, get help immediately through your pediatrician or a local child protective agency. Physicians are legally obligated to report all suspected cases of abuse or neglect to state authorities. Your pediatrician also will detect and treat any medical injuries or ailments, recommend a therapist, and provide necessary information to investigators. The doctor also may testify in court if necessary to obtain legal protection for the child or criminal prosecution of a sexual abuse suspect. Criminal prosecution is rarely sought in mild physical abuse cases but will occur in cases involving sexual abuse. If he has been abused, your child will benefit from the services of a qualified mental health professional. You and other members of the family may be advised to seek counseling so that you'll be able to provide the support and comfort your child needs. If someone in your family is responsible for the abuse, a mental health professional may be able to treat that person successfully, as well. If your child has been abused, you may be the only person who can help him. There is no good reason to delay reporting your suspicions of abuse. Denying the problem will only make the situation worse, allowing the abuse to continue unchecked and decreasing your child's chance for a full recovery. In any case of child abuse, the safety of the abused youngster is of primary concern. He or she needs to be in a safe environment free of the potential for continuing abuse. * What kind of people abuse children? * Are people who abuse children also prior victims of abuse themselves? * Does counseling help perpetrators of abuse? * What risk factors increase a child's likelihood of being physically abused? Answers Q. What kind of people abuse children? A. Ordinary, everyday people. Your neighbors. Your extended family. People you might never suspect. Sexual abuse is almost always done by someone known to the child. Physical abuse is almost always committed by a family member or a surrogate parent. People under stress, who are frustrated or angry, are more likely to lash out at children. In the case of babies who are shaken, the abuser sometimes doesn't understand the damage that can be done. Q. Are people who abuse children also prior victims of abuse themselves? A. Many are, but not all. Studies estimate 30 to 60 percent of abusers were themselves abused. But abuse is only part of the story. Adults who abuse children physically may not have been abused themselves, but they likely had little nurturing or had poor role models. Such a history may spawn adults with poor self-images and poor parenting skills. These are ingredients in the makeup of an abuser. None of these factors excuses the abuse, but it may hold the key to helping the abuser. Q. Does counseling help perpetrators of abuse? A. Yes, at least in some cases. But it's by no means easy. Overcoming perpetrators' denial and helping them learn empathy toward their victims are key issues for counseling. Counseling is more likely to succeed with perpetrators of physical abuse than sexual abuse. Sexual abuse often goes on a long time, becomes a pattern, and coexists with other issues, such as domestic violence, poverty, or mental illness. The psychological problems that lead to someone committing sexual abuse are complex and difficult to overcome. Q. What risk factors increase a child's likelihood of being physically abused? A. Younger children are more likely to be abused. More than half of abuse victims are under age 5. Not only are younger children more likely to be abused, but they're more likely to be seriously injured or killed. Younger children are more likely to be abused because they don't meet unrealistic expectations of parents. History of mental illness, lack of impulse control and lack of family or community support systems for parents or caregivers are also key risk factors in abuse. Parents with a better understanding of child development and what a child's capabilities are at a given age are less likely to become abusers. * What should I do if I witness child abuse in a public place? * I've heard that babies get brain injury if they are shaken. How can I avoid injuring my baby's brain? * How can I prevent child sexual abuse? Q. What should I do if I witness child abuse in a public place? A. It depends on the circumstances. If the child is at risk it's critical to intervene immediately, perhaps by calling the police or asking a store manager to call police. In less severe cases, you can help by trying to calm the parent. Try: * Identifying with the parent. Say something like: "My child gets tired when we wait for the bus, too." * Distracting the parent. Start a friendly conversation, say something nice, ask for directions or think of a question that might help the parent cool down long enough to calm down. * Offering help. If a parent is trying to juggle several things at once, offer to help by carrying bags, etc. * Standing guard. If a child has been left alone in a cart or a parked car, keep an eye out for danger. As a general rule, be positive. Dirty looks or negative comments will only make things worse. Try to calm the parent, and try to take the attention off of the child being abused. Appear supportive of the parent. The first priority is to try to provide for the safety of the child. If you're threatened, however, you need to call the police immediately. You may also want to call child welfare authorities. Q. I've heard that babies get brain injury if they are shaken. How can I avoid injuring my baby's brain? A. Normal play activity -- such as holding babies in the air and jiggling them -- will not cause the brain injuries known as shaken baby syndrome. It takes more forceful shakes. If you have a fussy baby who has been fed and has a clean diaper, attempt to soothe her with talking, singing, rocking, walking or car rides. Sometimes, nothing helps. If the crying continues, and you've tried everything to help, you may simply need to put the baby in bed and let her cry until she stops or goes to sleep. If you feel yourself losing control, put your baby down and ask a friend, relative or neighbor for help. Parents should discuss the dangers of shaking with all of the babies caregivers, including spouses, significant others, grandparents, siblings, baby sitters and day care providers. Q. How can I prevent child sexual abuse? A. As soon as the child has verbal skills, start talking about private parts and proper and improper touching. Teach children that it's okay to say "NO!" even to an adult. Teach assertive ways to say no confidently, both verbally and non-verbally, such as standing up straight and using a serious tone of voice. Try asking the child questions to help them prepare for potential situations, such as: * What do you do if someone tries to touch you in a way that makes you uncomfortable? * What if someone you know pretends to touch you by accident? * What if you are playing outside and a stranger asks you to help find a lost dog or take a ride in a car? * What if someone tells you they will give you money to go with them and can keep a secret? * What if you were in bed at night and someone in your house came into your room and touched your private parts, saying you should never tell? Also talk to children about how to get away if someone doesn't stop when they say no. Teach them they can yell, fight or make a scene to get away from danger. Reassure children that they can always tell you things they've done or things that have happened to them and that you will always love them no matter what. Teach your children that sometimes abuse occurs even if you try to stop it, and it isn't their fault. And tell them that no one should ever ask them to keep a secret about touching from their parents or caregivers. * How can I tell if my child has been physically abused? * What should I do if I suspect my child has been physically abused? * My child bruises easily. Will I be accused of child abuse? * When is masturbation abnormal? * How can I tell if my child has been sexually abused? * Do children make up stories of abuse that never occurred? * When I bring my child to the emergency room for an injury, I'm afraid I'll be accused of child abuse. What should i say to the doctors and nurses when I bring my child in with an injury? * My daughter (or son) has genital (or rectal) warts (or herpes). Does this mean he/she was sexually abused? * My child's doctor says her vaginal examination was normal, but she says she was penetrated. How can this be so? * Can bicycle injuries or other straddle-type injuries break my daughter's hymen? Answers Q. How can I tell if my child has been physically abused? A. If your child tells you of abuse, listen to what he/she has to say and report your concerns to the child welfare agency. Younger children may show signs of abuse in the form of injuries that can't be easily explained as coming from normal childhood accidents. Some types of injuries are suspicious or indicative of abuse. These include: * Injuries that occur in a pattern or show the markings of the implement used to inflict the injuries -- e.g., belts, buckles, cords, cigarette burns, etc. * Immersion burns, in which the child has been dipped in scalding water, which are indicated by sharply defined areas of redness * Bruises on children who don't walk yet * Unexplained fractures, lacerations or abrasions * Evidence of delayed or inappropriate treatment for injuries Some behaviors, or behavior changes, may also stem from physical abuse. These include: * Withdrawal * Self-destructive behavior * Aggression * Fear of being at home or running away from home * Bizarre, inconsistent or improbable explanations of injuries * Wariness of adult contact and apprehensiveness with others Q. What should I do if I suspect my child has been physically abused? A. Please call the police or child welfare agency in the jurisdiction where you live. Talk to them about your concerns, and they may be able to help you clarify what may be happening. Q. My child bruises easily. Will I be accused of child abuse? A. All children who are physically active get bumps and bruises, which in themselves are not evidence of child abuse. Physicians look for a plausible history to explain bruises and a pattern of bruises consistent with a child's normal activity. Infants, because they don't walk and are not very active are not prone to bruising. Toddlers, however, typically have bruises on their shins and foreheads from running and falling into things -- but they don't normally have bruises in protected areas like the inside their thigh. The severity and the number of bruises are other factors physicians observe. If a child truly does bruise more easily than normal, that could be a sign of a serious problem that requires medical attention. Clotting disorders and some connective tissue diseases are among the conditions that may actually cause a child to bruise easily. Q. When is masturbation abnormal? A. When a child masturbates in public places and doesn't respond to limits placed on the behavior by caregivers -- that may be a sign that the child is doing it as a way to contain anxiety over abuse. Ordinarily, parents or caregivers can place limits on the behavior by explaining to the child that masturbation should be confined to private. Q. How can I tell if my child has been sexually abused? A. Pay attention to what your child is saying and doing and the kinds of fears they express. If they act in a different manner after returning from an overnight trip, ask if everything is okay. Major behavior changes also can signify abuse. These may include: * New fears of people or places * Withdrawal * Sexual play beyond what might be considered normal for the child's age * Fear that something is wrong with the genital area * Regression or baby-like behavior * Sleep disturbances or nightmares The most important thing is to have a strong enough relationship with your child that they will tell you about problems. Q. Do children make up stories of abuse that never occurred? A. Rarely. Most stories about abuse that never occurred come from adults. Very young children, in particular, are unlikely to make up stories, because they haven't had any experiences that would allow them to fabricate them. A skilled interviewer experienced with child sexual abuse should be brought in to talk with the child immediately upon a report being made. Q. When I bring my child to the emergency room for an injury, I'm afraid I'll be accused of child abuse. What should I say to the doctors and nurses when I bring my child in with an injury? A. This is a concern often in the back of parents' minds, because they've heard stories of how child abuse is frequently seen in the emergency room. When doctors and nurses start asking parents about the specifics of how an injury occurred, parents sometimes feel they're being interrogated. Parents should keep in mind that physicians and nurses need to be looking for child abuse, because they'll miss opportunities to protect children if they don't. They also need to have a thorough understanding of how injuries occur in order to provide the best care. Parents who bring their children in for accidental injuries should not hesitate to answer questions and shouldn't feel they're being singled out. Q. My daughter (or son) has genital (or rectal) warts (or herpes). Does this mean he / she was sexually abused? A. Genital warts and herpes are conditions that are frequently sexually transmitted, but sexual contact is only one of the ways children can get these infections. Both conditions also can be spread through non-sexual touching. Your child may have a wart or herpes infection elsewhere on her / his body and spread the infection to the genitalia or rectum. When children are diagnosed with an infection that can be transmitted sexually, a parent and physician should investigate for possible sexual abuse. A physician or social worker will likely interview your child to see if he / she provides a history of abuse and perform an examination and tests to see if he / she has any other physical indications of sexual abuse, such as presence of other sexually transmitted diseases or physical injuries. Barring other indications, physicians at Cincinnati Children's do not report children as possible victims of abuse to child welfare or law enforcement agencies simply on the basis of genital or rectal warts or herpes. Q. My child's doctor says her vaginal examination was normal, but she says she was penetrated. How can this be so? A. In some cases, even when vaginal penetration has occurred, a medical examination will not detect it. Other times, the examination may suggest penetration when in fact none has occurred. The idea that a girl's hymen is always broken if penetration occurs is a myth. Prior to puberty, a girl's vaginal opening is quite small. Her hymen is tissue that partially covers the vaginal opening. Often -- but not always -- penetration beyond the hymen and into the vagina will cause damage that a physician will observe. Contact around and to the hymen, however, may cause pain to the child without producing noticeable injury. The child may describe this degree of contact as penetration, and in some states it constitutes legal penetration. After the onset of puberty, the opening of the vagina becomes enlarged. Penetration beyond the hymen then may occur more often without any tearing or signs of injury to the hymen. Q. Can bicycle injuries or other straddle-type injuries break my daughter's hymen? A. Most straddle injuries do not result in injury to the hymen. Examining and Treating Victims of Child Abuse * Does counseling help child abuse victims? * Why do doctors order x-rays when testing for physical abuse? Should I let them take the x-rays? Isn't all that radiation bad? * Will my child ever get over the abuse? * Can my child get AIDS (HIV) from sexual abuse? * Can a doctor make a determination of sexual abuse after a physical examination? * I don't want my daughter upset by the examination. Can she be sedated? * How painful is the physical examination for sexual abuse? Is it like an adult pelvic examination? * What types of sexual abuse are consistent with normal examinations? * Can the number of abuse episodes and when they occurred be determined by exam? * Why does one examiner's report differ from another's? Answers Q. Does counseling help child abuse victims? A. Yes -- and they need it immediately. First, the child has to be in a safe environment. After that, counseling should begin. Abused children need help expressing their fears and other emotions and coming to grips with the abuse. Besides the victim, every family member should receive counseling. Forgetting is not the answer. The best way to break the cycle of abuse and prevent an abuse victim from becoming an abuser is to intervene early. This is the best time to make a positive impact on the victim's life. Even children age 2 and younger need counseling. Abused toddlers are likely to act the abuse out in their play with other children. So counseling may take the form of play therapy combined with counseling parents or caregivers on how to set limits on behavior. Especially in cases of sexual abuse, counseling "booster shots" can be valuable. Revisiting issues of abuse at various stages of development can help the victim learn to come to terms with it in different ways as he or she matures emotionally and mentally. Q. Why do doctors order x-rays when testing for physical abuse? Should I let them take the x-rays? Isn't all that radiation bad? A. Doctors order x-rays to look for fractures. Specialized imaging, such as CAT scans and MRIs, may be ordered to look for bleeding in the brain, which can result from child abuse. Such imaging is the only real way to find these problems. The amount of radiation from x-rays and other more advanced forms of imaging is actually fairly small. Even a full skeletal survey, the most extensive form of ordinary x-rays that obtains an image of every bone in the body, is only equivalent to a year's worth of everyday background radiation that your child would encounter by just walking around. A CAT scan is the equivalent of two years of background radiation. An x-ray of the hand amounts to only a day's worth of background radiation. And x-ray of an arm is equivalent to about a week. The increased risk of cancer from even the most extensive of these procedures is fairly small. Q. Will my child ever get over the abuse? A. With proper support from parents and caregivers and professional counseling, it is possible for children to get over sexual or physical abuse and live normal, healthy lives. Children who have the best prognosis are those who have good relationships with parents and receive professional counseling. It also helps for children to receive counseling "booster shots" after the abuse occurs. This can help children deal mentally and emotionally with the abuse at various stages of development. Q. Can my child get AIDS (HIV) from sexual abuse? A. It depends on what happened. If the child has been fondled or penetrated with a finger, there is virtually no risk. If the abuse involved oral sex, infection is possible but very unlikely. If the abuse involved genital-to-genital contact, the risk is greater but still rare. The risk is greater in parts of the country, such as major metropolitan areas, where HIV infection is widespread. Likewise, a child is at increased risk for other sexually transmitted disease from genital-to-genital or oral-genital contact. Q. Can a doctor make a determination of sexual abuse after a physical examination? A. Sometimes. In most cases, even when a perpetrator confesses, the physical examination of the child reveals no physical evidence of abuse. If vaginal penetration occurred, great force was used or the abuse was repetitive, it is more likely that physical evidence will be present. Q. I don't want my daughter upset by the examination. Can she be sedated? A. Sedation may be offered if the examination must be completed and your daughter is overly upset. Before sedation is considered, the physician, nurse or social worker will explain the examination to your daughter and attempt to reassure her. If the examination can be deferred, her examination be rescheduled for a time when she may be more emotionally able to consent to the examination. Q. How painful is the physical examination for sexual abuse? Is it like an adult pelvic examination? A. The examination is not physically painful. It mainly involves visual examination with minimal physical contact. Unlike adult pelvic examinations, an internal examination is usually not required in young children. Q. How painful is the physical examination for sexual abuse? Is it like an adult pelvic examination? A. The examination is not physically painful. It mainly involves visual examination with minimal physical contact. Unlike adult pelvic examinations, an internal examination is usually not required in young children. Q. What types of sexual abuse are consistent with normal examinations? A. Oral contact, digital fondling, genital rubbing, vaginal penetration after puberty, rectal penetration, partial or attempted vaginal penetration, and penetration that has had time to heal. Q. Can the number of abuse episodes and when they occurred be determined by exam? A. The examiner usually cannot determine the number of episodes that occurred. If evidence of chronic anal abuse is present, multiple episodes of abuse occurred. Vaginal injuries do not reliably differentiate between single episodes of abuse and multiple episodes. If the injuries are acute (redness, swelling, tenderness, fresh abrasions or tears), the examiner may reliably identify the injury as relatively recent, most likely having occurred within a few days of the examination. Dating injuries within hours or to specific days is usually not possible. Q. Why does one examiner's report differ from another's? A. Examination findings may differ when: * Acute injuries heal between examinations * One of the examinations was not optimal because the child was uncooperative * The skill levels of the examiners differ (Examiners with expert training will provide a more accurate and informative examination.) Reporting Child Abuse * Whom do I call to report abuse? * What happens after I report abuse? * What should I do if I think my child has been sexually abused? * Will my child have to testify in court? Q. Whom do I call to report abuse? A. Contact the child welfare agency or police in the jurisdiction where you live and / or where the incident occurred. Q. What happens after I report abuse? A. The child welfare agency and the police are required to do an investigation and assessment within a given time frame, with response times that range from hours to days depending on the severity of the particular case. Q. What should I do if I think my child has been sexually abused? A. Please call your pediatrician and / or the local child protective agency within 24 hours. If the assault may have occurred within the past 72 hours, they may refer you to a hospital for a medical evaluation that would detect possible evidence. Q. Will my child have to testify in court? A. In most cases, no. Only a small minority of cases go to trial. Child abuse cases frequently are plea bargained, which means the child won't need to testify in court, though he or she may still be interviewed by police, prosecutors and attorneys. When children are needed for testimony, many communities have victim advocate programs who help them through the process and relieve stress. Sometimes, adults may be permitted to testify to what children have said regarding an incident, or videotaped testimony or depositions may be permitted. When Should You Start Potty Training? Q. My son is 2 1/2 years old and has no interest in using the potty. Is that normal? A. Most children begin potty training sometime around 18 months to three years of age, so yes, if he is otherwise growing and developing well, it is probably normal that a 2 1/2 year old does not want to use the potty. Although many parents feel like 3 years is a magic age by which their child must be potty trained, that is not always the case. A recent poll on keepkidshealthy.com showed that almost 25% of kids weren't potty trained until they were 3 1/2 or 4 years old. Even in an older child, it is important to look for signs of readiness before you begin potty training, including: * staying dry for at least 2 hours at a time * having regular bowel movements * being able to follow simple instructions * being uncomfortable with dirty diapers and wanting them to be changed * asking to use the potty chair * asking to wear regular underwear. You should also be able to tell when your child is about to urinate or have a bowel movement by his facial expressions, posture or by what he says. If your child has begun to tell you about having a dirty diaper you should praise him for telling you and encourage him to tell you in advance next time. Even if your child isn't totally ready to begin potty training, you can still get him a potty chair and have him decorate it with stickers and sit on it with his clothes on to watch TV, etc. to help him get used to it. Whenever your child shows signs of needing to urinate or have a bowel movement you should ask him if he wants to use the potty or take him to the chair and explain to him what you want him to do. Only keep him seated for a few minutes at a time, don't insist and prepared to delay training if he shows resistance. Until he is going in the potty, you can try to empty his dirty diapers into his potty chair to help demonstrate what you want him to do. Another good techniques is modeling, where you allow your child to see family members or other children using the toilet, and using observational remarks. This involves narrating what is happening and asking questions while potty training, such as 'did you just sit on the potty?' or 'did you just poop in the potty?' Things to avoid when toilet training your child are beginning during a stressful time or period of change in the family (moving, new baby, etc.), pushing your child too fast, and punishing mistakes (treat accidents and mistakes lightly). Be sure to go at your child's pace and show strong encouragement and praise when he is successful. When did you start and finish potty training your child? Is My Child Too Young for Potty Training? When Should Puberty Start? Q. My daughter is 9 years old and is beginning to 'develop'. Is it normal for children to start puberty so young? A. Yes. In general, 9 is a very appropriate age for your child to start puberty. Puberty normally occurs in a series of five stages (Tanner stages) that typically begin within the ages of 8 and 13 for girls and 9 and 14 for boys. Puberty is consider early (precocious) if it occurs before the age of 8 years in girls and 9 years in boys. And puberty is considered late or delayed if it has not begun prior to the age of 13 years for girls and 14 years for boys. Recent studies have shown that puberty is occurring at an increasingly earlier age in children though. The first sign of puberty in girls, which occurs at an average age of 10 1/2 years, is breast development (thelarche). This begins with breast budding, or the formation of small lumps or nodules under one or both nipples. These lumps may be tender and they may be different sizes at first. This is usually also the beginning of their growth spurt. Next, in about six months, pubic hair develops (adrenarche), although in some children, pubic hair is the first sign of puberty, and then axillary hair begins to grow. Over the next few years, breast size will continue to increase and there will be a progressive increase in development of pubic hair and the external genitalia, leading to the first period or menarche (occurring at an average age of 12 1/2 to 13 years), which usually occurs about two years after puberty begins and coincides with their peak in height velocity. Development continues and the whole process is completed in 3-4 years, eventually reaching adult breast and areolar size and an adult pattern of pubic hair. A child will have also reached her final adult height about two years after menarche. Puberty generally begins later in boys, at an average age of 11 1/2 to 12 years. The first sign of puberty in boys is an increase in size of the testicles. This is followed a few months later by the growth of pubic hair. Puberty continues with an increase in size of the testicles and penis and continued growth of pubic and axillary hair. Boys undergo their peak growth spurt about 2-3 years later than girls. Also, this usually begins with an enlargement of the hands and feet and is later followed by growth in the arms, legs, trunk and chest. Other changes include a deepening of the voice, an increase in muscle mass, the ability to get erections and ejaculate (especially spontaneous nocturnal emissions or 'wet dreams'), and in some boys, breast development (gynecomastia). Development continues and the whole process is completed in 3-4 years, eventually reaching adult testicle and penis size and an adult pattern of pubic hair. This is followed by the development of chest and facial hair. Puberty is also associated with adolescents beginning to have axillary perspiration and body odor, and acne. What is Child Abuse and Neglect? What Are the Major Types of Child Abuse and Neglect? Federal legislation provides a foundation for States by identifying a minimum set of acts or behaviors that define child abuse and neglect. The Federal Child Abuse Prevention and Treatment Act (CAPTA), (42 U.S.C.A. §5106g), as amended by the Keeping Children and Families Safe Act of 2003, defines child abuse and neglect as, at minimum: * Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or * An act or failure to act which presents an imminent risk of serious harm. What Are the Major Types of Child Abuse and Neglect? Within the minimum standards set by CAPTA, each State is responsible for providing its own definitions of child abuse and neglect. Most States recognize four major types of maltreatment: neglect, physical abuse, sexual abuse, and emotional abuse. Although any of the forms of child maltreatment may be found separately, they often occur in combination. The examples provided below are for general informational purposes only. Not all States' definitions will include all of the examples listed below, and individual States' definitions may cover additional situations not mentioned here. Neglect is failure to provide for a child's basic needs. Neglect may be: * Physical (e.g., failure to provide necessary food or shelter, or lack of appropriate supervision) * Medical (e.g., failure to provide necessary medical or mental health treatment) * Educational (e.g., failure to educate a child or attend to special education needs) * Emotional (e.g., inattention to a child's emotional needs, failure to provide psychological care, or permitting the child to use alcohol or other drugs) These situations do not always mean a child is neglected. Sometimes cultural values, the standards of care in the community, and poverty may be contributing factors, indicating the family is in need of information or assistance. When a family fails to use information and resources, and the child's health or safety is at risk, then child welfare intervention may be required. Physical Abuse is physical injury (ranging from minor bruises to severe fractures or death) as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object), burning, or otherwise harming a child. Such injury is considered abuse regardless of whether the caretaker intended to hurt the child. Sexual Abuse includes activities by a parent or caretaker such as fondling a child's genitals, penetration, incest, rape, sodomy, indecent exposure, and exploitation through prostitution or the production of pornographic materials. Emotional Abuse is a pattern of behavior that impairs a child's emotional development or sense of self-worth. This may include constant criticism, threats, or rejection, as well as withholding love, support, or guidance. Emotional abuse is often difficult to prove and, therefore, CPS may not be able to intervene without evidence of harm to the child. Emotional abuse is almost always present when other forms are identified. Preventing Child Abuse As an individual and as a member of your community, you have the power to prevent child abuse and neglect. Here are some ways to contribute your ounce—or more—of effort to prevention. * Understand the problem. Child abuse and neglect affect children of all ages, races, and incomes. According to the National Child Abuse and Neglect Data System, in 2001, an estimated 903,000 children nationwide were victims of maltreatment. Most experts believe that actual incidents of abuse and neglect are more numerous than statistics indicate. * Understand the terms. Child abuse and neglect take more than one form. Federal and State laws address four main types of child maltreatment: physical abuse, physical or emotional neglect, sexual abuse, and emotional abuse. Often more than one type of abuse or neglect occurs within families. Some types of maltreatment, such as emotional abuse, are much harder to substantiate than others, such as physical abuse. * Understand the causes. Most parents don't hurt or neglect their children intentionally. Many were themselves abused or neglected. Very young or inexperienced parents might not know how to take care of their babies or what they can reasonably expect from children at different stages of development. Circumstances that place families under extraordinary stress - for instance, poverty, divorce, sickness, disability - sometimes take their toll in child maltreatment. Parents who abuse alcohol or other drugs are more likely to abuse or neglect their children. * Support programs that support families. Parent education, community centers, respite care services, and substance abuse treatment programs help to protect children by addressing circumstances that place families at risk for child abuse and neglect. Donate your time or money, if you can. * Report suspected abuse and neglect. Some States require everyone to report suspected abuse or neglect; others specify members of certain professions, such as educators and doctors. But whether or not you are mandated by law to report child abuse and neglect, doing so may save a child - and a family. If you suspect a child is being abused or neglected, call the police or your local child welfare agency. * Spread the word. Help educate others in your community about child abuse and neglect. See the list below for sources of free materials. Ask if you can leave a stack of brochures at your local public library, recreation or community center, government center, or other public place. You also might make material available at your church, synagogue, mosque, temple, or other faith institutions. Even grocery stores usually have places to distribute community materials. * Strengthen the fabric of your community. Know your neighbors' names and the names of their children, and make sure they know yours. Give stressed parents a break by offering to watch their children. Volunteer. If you like interacting with children, great, but you do not have to volunteer directly with kids to contribute to prevention. All activities that strengthen communities, such as service to civic clubs and participation on boards and committees, ultimately contribute to the well-being of children. Recognizing and Reporting Child Abuse Q. I know someone that has their four year old son on Risperdal for ADHD. I have babysat for the child before and do not feel that he is in need of the medication. She has changed pediatricians five times since his time of birth for no apparent reason except that the doctor wouldn't do what she wanted them to do. I would like to know if there is anything that can or should be done about the situation. As an observer, I feel that the child is just a child and acting his age. There are times when I watch him that he has minor cuts, bruises, or even burns. His mother always has sound reasons. Are there things to look for to show abuse or neglect or something else that is underlying? Should I notify anyone of my concerns or am I being overly paranoid? Sincerely, Silent Observer A. Well, some people would say that you are being paranoid, but others would say that you should trust your instincts and report the situation to someone. It is important to keep in mind that there are consequences either way, whether your report the situation or not. If you report the family and he is not being abused, then they have to deal with a child protective services investigation and the hope that they recognize that there is no abuse. On the other hand, if you don't report it and the child is being abused, there might be tragic consequences down the road if the abuse escalates. Have you ever seen the child when he is off any medications? If not, then it is hard for you to say that he doesn't need them. Do you believe her 'sound reasons' for those cuts, bruises, and burns? Having 'unexplained burns, bites, bruises, broken bones, or black eyes,' can be a sign of physical abuse, especially if the parent offers 'conflicting, unconvincing, or no explanation for the child's injury.' According to the National Clearinghouse on Child Abuse and Neglect Information, the following signs may signal the presence of child abuse or neglect: Signs of Child Abuse in 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. Signs of Child Abuse in 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 caretakers 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. Signs of Child Abuse in The Parent and Child * Rarely touch or look at each other. * Consider their relationship entirely negative. * State that they do not like each other. How to Report Child Abuse If you suspect that a child is being abused or neglected, you should call your local Child Protective Services (CPS) agency or the CPS agency in the State in which the abuse occurred. As you identify the appropriate agency for making a report, remember the following: * Not every State has a toll free hotline, or the hotline may not operate on a 24 hour basis. * If a toll free (800 or 888) number is available, it may be accessible only from within that State. * Federal agencies have no authority to intervene in individual child abuse and neglect cases. Each State has jurisdiction over these matters, and has specific laws and procedures for reporting and investigating. In some States, all citizens are mandated reporters by State law and must report any suspicion of child abuse or neglect. We have listed below the toll free numbers for the States that have them. If a number is not listed, or if you need to report suspected abuse in a State other than your own, please call: Child Abuse Facts Child abuse is harm to, or neglect of, a child by another person, whether adult or child. Child abuse happens in all cultural, ethnic, and income groups. Child abuse can be physical, emotional - verbal, sexual or through neglect. Abuse may cause serious injury to the child and may even result in death. Signs of possible abuse include: Physical Abuse * Unexplained or repeated injuries such as welts, bruises, or burns. * Injuries that are in the shape of an object (belt buckle, electric cord, etc.) * Injuries not likely to happen given the age or ability of the child. For example, broken bones in a child too young to walk or climb. * Disagreement between the child's and the parent's explanation of the injury. * Unreasonable explanation of the injury. * Obvious neglect of the child (dirty, undernourished, inappropriate clothes for the weather, lack of medical or dental care). * Fearful behavior. Emotional - Verbal Abuse * Aggressive or withdrawn behavior. * Shying away from physical contact with parents or adults. * Afraid to go home. Sexual Abuse * Child tells you he/she was sexually mistreated. * Child has physical signs such as: o difficulty in walking or sitting. o stained or bloody underwear. o genital or rectal pain, itching, swelling, redness, or discharge o bruises or other injuries in the genital or rectal area. * Child has behavioral and emotional signs such as: o difficulty eating or sleeping. o soiling or wetting pants or bed after being potty trained. o acting like a much younger child. o excessive crying or sadness. o withdrawing from activities and others. o talking about or acting out sexual acts beyond normal sex play for age. Abuse can happen in any family, regardless of any special characteristics. However, in dealing with parents, be aware of characteristics of families in which abuse may be more likely: * Families who are isolated and have no friends, relatives, church or other support systems. * Parents who tell you they were abused as children. * Families who are often in crisis (have money problems, move often). * Parents who abuse drugs or alcohol. * Parents who are very critical of their child. * Parents who are very rigid in disciplining their child. * Parents who show too much or too little concern for their child. * Parents who feel they have a difficult child. * Parents who are under a lot of stress. If you suspect child abuse of any kind, you should: * Take the child to a quiet, private area. * Gently encourage the child to give you enough information to evaluate whether abuse may have occurred. * Remain calm so as not to upset the child. * If the child reveals the abuse, reassure him/her that you believe him/her, that he/she is right to tell you, and that he/she is not bad. * Tell the child you are going to talk to persons who can help him/her. * Return the child to the group (if appropriate). * Record all information. * Immediately report the suspected abuse to the proper local authorities. In most states, reporting suspected abuse is required by law. If you employ other providers or accept volunteers to help you care for the children in your facility, you should check their background for a past history of child abuse or other criminal activity. Contact your local police department. Many states require that child care providers have background and criminal history checks. Dealing with child abuse is emotionally difficult for a provider. As a child care provider, you should get training in recognizing and reporting child abuse before you are confronted with a suspected case. If you suspect a case of child abuse, you may need to seek support from your local health department, child support services department, or other sources. Signs of Physical Abuse Physical abuse of children includes any nonaccidental physical injury caused by the child's caretaker. It may include injuries sustained from burning, beating, kicking, punching, and so on. While the injury is not an accident, neither is it necessarily the intent of the child's caretaker to injure the child. Physical abuse may result from extreme discipline or from punishment that is inappropriate to the child's age or condition, or the parent may experience recurrent lapses in self-control brought on by immaturity, stress, or the use of alcohol or illicit drugs. Some children are more susceptible to being maltreated than others. Some require a great deal of care (e.g., premature babies or disabled or developmentally delayed children), and others may be difficult to raise (e.g., hyperactive children, children with behavioral problems). These children would fare well in some families, but not in other families where the burden is too great for the parents to cope with the special needs of these children. Regardless of whether the child has special needs or not, signs of physical abuse often are difficult to interpret with absolute certainty and may be confused with normal childhood injuries, such as bruises. Behavioral Clues That May Indicate Child Abuse Although there are many other potential indicators, the abused child may: * Be aggressive, oppositional, or defiant * Cower or demonstrate fear of adults * Act out, displaying aggressive or disruptive behavior * Be destructive to self or others * Come to school too early or not want to leave school—indicating a possible fear of going home; * Show fearlessness or extreme risk taking * Be described as "accident prone" * Cheat, steal, or lie (may be related to too high expectations at home) * Be a low achiever (to learn, children must convert aggressive energy into learning; children in conflict may not be able to do so) * Be unable to form good peer relationships * Wear clothing that covers the body and that may be inappropriate in warmer months (be aware that this may be a cultural issue as well) * Show regressive or less mature behavior * Dislike or shrink from physical contact—may not tolerate physical praise such as a pat on the back) Since children typically receive bruises during the course of play or while being active, the leading or bony edges of the body, such as knees, elbows, forearms, or brows, are most likely to be bruised. The soft tissue areas, such as cheeks, buttocks, and thighs, are not normally injured in such circumstances. Additionally, bruises received during the normal course of childhood activity are rarely in distinct shapes, such as a hand, belt buckle, or adult teeth marks. Bruises in soft tissue areas or in distinct shapes are much more indicative of physical abuse. Unlike bruises, abuse directed to the abdomen or the head, which are two particularly vulnerable spots, often are undetected because many of the injuries are internal. Injuries to the abdomen can cause swelling, tenderness, and vomiting. Injuries to the head may cause swelling in the brain, dizziness, blackouts, retinal detachment, or even death. Referred to more recently as the "shaken baby" syndrome, violent shaking can cause severe damage in children at any age. Children who are being abused may demonstrate a change in behavior. Many become more aggressive, destructive, fearful, or withdrawn. Often, in an effort to avoid the abuse, they will stay away from home as much as possible. They may see school as a safe environment. Some children are abused because their parents have higher expectations of them than the children are able to achieve or because the expectations are developmentally inappropriate. The case example below illustrates this point. Case Example Sandy was 10 years old when her teacher became concerned about possible abuse. She was extremely shy and withdrawn and often took a great deal of time to grasp ideas, despite the fact that testing showed no significant organic or perceptual difficulties. Her mother, a professional artist who had chosen to stay home with her four children, and her father, an accountant, found Sandy's slowness especially distressing. As the homework required of Sandy increased, she became more withdrawn. The teacher suggested she ask for help at home, especially with her math. At first Sandy began coming to school with peculiar marks on her hands and arms. On another day she arrived with a burn mark covering a good part of her hand. It had not been treated and had become infected. In asking Sandy about her injuries, the teacher learned that Sandy was being abused by her father. After several drinks, he would "help her" with her homework, become angered by her slowness, and prod her with his lit cigarette. The latest burn was a result of Sandy's hand being pressed on an iron when her father had taken over her mother's efforts to teach Sandy how to "iron properly." Sandy's story of parents who expect too much is common. The child's withdrawn behavior was indicative of her poor self-concept and exacerbated by her experiences at home. Cigarettes are tools for abuse due to their ready accessibility, as are objects such as irons, electric cords, and other household items. Substance abuse also may be a factor in child maltreatment cases. Despite their need for help, many children and adolescents do not initially admit to being abused. Rather they often may invent seemingly plausible explanations, but the explanations tend not to fit the injury. Despite the abuse, children often are understandably fearful of being taken from their families or getting their parents into trouble. Other children also may just assume that this behavior is normal. Sometimes, it is assumed that physical abuse does not occur typically with adolescents or that, since they often are more difficult or provocative, they "invite" abuse. After all, adolescents are stronger, have more resources, and can run away. In fact, neither resistance nor flight is a good option for most adolescents. Resistance might further ignite their parents' anger, and unless they want to deal with the harsh realities of life on the street, flight is not an option for most adolescents. In addition, since adolescents often are perceived as more capable, adults are less likely to intervene or alert them to the resources available that can address personal or family issues. Case Example Dara, a ninth-grade student, began complaining to her gym teacher after a particularly intense argument with her parents. Despite her complaints, Dara insisted that her bruised face was the result of "bumping into a door." The teacher suspected otherwise because of the location of the bruise and Dara's frightened demeanor, but chose not to act. It was not until Dara began vomiting several months later and was doubled over in pain that the situation came to anyone's attention. It was discovered that Dara had internal injuries from a severe blow to the abdomen. The girl finally admitted to the teacher about months of physical abuse she received from her father. Abuse situations similar to Dara's happen to adolescents for various reasons. In Dara's home, adolescence, with its emerging sexuality, created problems. Her father sought to control her with force, perhaps fearful that she would become pregnant before marriage, as her sister had done. The fear of losing a child can sometimes paradoxically drive parents to abuse. In other homes, physical punishment already present may increase and escalate into abuse as the child matures. Reporting Suspected Child Abuse In all of the case examples, family or school personnel became aware of physical or behavioral symptoms and family patterns that, in a composite, pointed to either abuse or the exposure to abuse (such as observing, hearing, or intervening in domestic violence or dealing with the subsequent fears and behaviors, which some States define as child maltreatment). It also is important for those working with children to be sensitive to comments about severe physical fights between the parents that might indicate the presence of domestic violence. A child who speaks of caretakers who sleep a great deal during normally wakeful hours may be living with substance abusers or individuals suffering from clinical depression. Extremely erratic behavior described by the child on the part of the parent might suggest other types of mental illness. Educators must learn to listen "between the lines" as children make comments about their homes. Sometimes this will give vital clues about the conflict with which they are dealing. While symptoms do not necessarily indicate abuse, any suspected child abuse legally must be reported to child protective services (CPS) to be assessed or investigated. Directly communicating with CPS or using the school's protocol, in combination with the educator's common sense and concern for the students, will help identify what information will be needed to file a report. See Appendix F - Sample Report of Suspected Child Abuse and Neglect, for an example of a school reporting protocol. Sample Report of Suspected Child Abuse and Neglect Abuser Administrator Principal Teacher Staff Call: Local Social Services Agency or Law Enforcement Agency (Phone Numbers) Date of Call(s):_________________________ Name of Person(s) Talked To:____________________ Notified: Designee (Principal or School Social Worker) Date of Notification:________________________ Date of this Report:__________________________ School: (School Name, Address, City, State, ZIP, Telephone Number) _______________________ Child's Last Name ______________ First Name ______ M. Init. ____ M/F ____ Age ________ Birth date _______________ Address ____________ City _________ State ____________ Zip Code _____________ Telephone Name of Person(s) Responsible for Child's Care: (Parents/Stepparents/Guardians/Custodial Parents) _______________ Address ____________ City _________ State ____________ Zip Code _____________ Telephone With Whom Does the Child Live:_____________________ Relationship:_________________________ _______________ Address ____________ City _________ State ____________ Zip Code _____________ Telephone Person(s) Suspected of Abuse or Neglect: Administrator Principal Teacher Staff Others ___________________ Relationship:_________________ _______________ Address ____________ City _________ State ____________ Zip Code _____________ Telephone Check ( appropriate space indicating type of suspected abuse being reported: ( ) Physical Injury ( ) Sexual Abuse ( ) Emotional Neglect/Abuse ( ) Physical Neglect ( ) Other (specify):______________________________________ State the nature and extent of the current injury, neglect, or sexual abuse to the child in question and circumstances leading to the suspicion that the child is a victim of abuse or neglect: Information concerning previous injury, sexual abuse or neglect experienced by this child or other children in this family situation, including previous action taken, if any: State other information that may be helpful in establishing the cause of the child' status: _______________________________________________________________________________________ _________________________________________________________________ Signature and Title of Person Making Report _________ Date Distribution: Local Social Services or Law Enforcement Agency/Designee/Other Long-Term Consequences of Child Abuse and Neglect The impact of child abuse and neglect is far greater than its immediate, visible effects. These experiences can shape child development and have consequences that last years, even lifetimes. Research now shows that the physical, psychological, and behavioral consequences of child abuse and neglect impact not just the child and family, but the community as a whole. Physical Consequences The immediate physical effects of abuse can range from relatively minor, such as a bruise or cut, to severe, such as broken bones, internal bleeding, or even death. Longer-term consequences may include: * Shaken Baby Syndrome (including blindness, learning disabilities, mental retardation, cerebral palsy, or paralysis) * Impaired brain development * Lifelong poor physical health Psychological Consequences The immediate psychological effects of abuse and neglect—isolation, fear, and a lack of trust—can spiral into long-term mental health consequences including: * Depression and anxiety * Low self-esteem * Difficulty establishing and maintaining relationships * Eating disorders * Suicide attempts Behavioral Consequences Studies have found abused or neglected children to be at least 25 percent more likely to experience problems in adolescence, including: * Delinquency * Teen pregnancy * Drug use * Low academic achievement As adults, children who experienced abuse or neglect have an increased likelihood of criminal behavior, involvement in violent crime, abuse of alcohol and other drugs, and abusive behavior. For more information, read Long-Term Consequences of Child Abuse and Neglect, from the National Clearinghouse on Child Abuse and Neglect Information, available at http://www.childwelfare.gov/pubs/factsheets/long_term_consequences.cfm. The Cycle of Child Abuse You see your child misbehaving, and you tell him to stop. He ignores you, and you tell him again. You are getting frustrated. He says OK, I will, then 10 minutes later the same thing is going on. You're really angry now. It feels like your authority as a parent means nothing. If other adults are around then it's even worse, you feel ineffective and inadequate. So you yell, I TOLD YOU TO STOP THAT RIGHT NOW. GET OVER HERE. You grab him by the arm when he comes to you, give him a shake, and tell him to go to his room. YOU'RE GOING TO GET A WHIPPING FOR NOT MINDING ME. A few minutes later you go into his room with the belt and spank his bottom with three good licks. Now, fast forward about ten years. He's fifteen, and you tell him to clean his room. He sighs, walks into his room, and slams the door.Thirty minutes later you check, and he hasn't done a thing in his room. In fact, he's on the phone with a friend, the TV is blaring, and a bag of chips is spilled on the floor now. You've had it with his defiance of your requests. You yell at him, YOU ARE SO LAZY. I TOLD YOU TO CLEAN UP IN HERE, AND YOU DELIBERATELY DEFIED ME. YOU'RE GOING TO GET A WHIPPING FOR NOT MINDING ME. He's heard that before and he's decided he's had enough. OH NO YOU'RE NOT. YOU'RE NOT GOING TO TOUCH ME. I'M GETTING OUT OF THIS PLACE. He bolts for the door and you grab him as he moves past you. He swings around and pushes you out of the way. You fall against the dresser and it hurts. You are livid. JUST WAIT UNTIL I GET YOU, you scream after him. The Cycle of Abuse follows a certain predictable pattern that begins when the child is young and gets progressively worse as the child becomes a teenager. Here are the steps you will see: 1. The child misbehaves. 2. The parent notices the child's misbehavior and gives him instructions to correct it. 3. The child does not comply. He may ignore the instructions, argue, or even refuse to do what the parent says. 4. The parent feels angry. The parent feels that his authority is being threatened. The parent yells at the child, shakes him, insults him, or hits him. 5. The child feels angry, resentful, and worthless. 6. The child's misbehavior becomes more ingrained and is now based on feelings of revenge and/or worthlessness. 7. The parent becomes more and more frustrated with the continued misbehavior and the entire cycle escalates until someone intervenes or someone gets hurt badly. You can see the potential for this cycle to occur in any family. Also apparent is the need for parents to learn effective ways to discipline their children without yelling and spanking. There are three primary intervention points in this cycle. * When giving instructions to the child After the child has failed to comply with the instructions With the child's feelings of worthwhileness and bonding with the parent Does anyone receive child support? Yes No Is there a stepparent in your home? Yes No Does anyone have high medical bills? Yes No Are you applying for a family member who has a disability? Yes No Are you applying for a family member who is 65 or older? Yes No It was not until the 19th century that children were granted the same legal status as domesticated animals with regard to protection against cruelty and/or neglect. In 1962, the term "battered child syndrome" became part of the medical vocabulary and by 1976 all of the states in the United States had adopted laws mandating the reporting of suspected child abuse. What is the scope of the child abuse problem? Child abuse is a worldwide problem affecting children from birth to 18 years of age. The most recent U.S. data dates from 2005, during which 3.3 million reports of abuse and neglect were filed. About 60% of these reports warranted investigation with one-half of these allegations substantiated. These data indicate the incidence of child abuse and neglect to be 12.1 per 1,000 children; 1,460 children (four children/day) died in 2005 as a result of inflicted trauma with more than 77% of these deaths in children less than 4 years of age. While "reports" of alleged child abuse are not always substantiated during the investigation process, most authorities believe that a large underreporting bias is inherent in the data. There is much more child abuse than gets reported. What age child is abused? All ages of children suffer from child abuse and neglect. Research has shown, however, that risk factors exist making it more likely that certain children may be abused. These risk factors include 1. age: 67% of abused children are less than 1 year old; 80% are less than 3 years old; 2. past history of abuse: Repeated abuse has been shown to occur more than 50% of the time; repeatedly abused children have a 10% chance of sustaining a lethal event; 3. children with learning disabilities, speech/language disorders and mental retardation; 4. children with congenital anomalies (malformations) and chronic/recurrent conditions; and 5. adopted and foster children. Complicating the collection of data is the general underreporting of child abuse. Very young children are incapable of verbally communicating the harm inflicted on them. Other factors such as fear, guilt, or confusion about the abuser's erratic behavior may also hinder younger children from informing on their abuser. Are girls more often abused than boys? Yes. Girls are somewhat more likely to be abused. According to statistics published in 1996, about 52% of victims of maltreatment were female and 48% were male. Data obtained in the federally funded 2005 study demonstrate no significant change in these values. Is the pattern of abuse different for girls and boys? Studies have shown a consistent pattern regarding the abuse and neglect inflicted on children of different genders. Approximately 75% of sexual abuse is inflicted upon girls. Girls also are more likely to suffer from emotional abuse and neglect. Boys, on the other hand, are more likely to experience physical trauma (other than sexual abuse). When focusing solely on cause of death, studies indicate fathers are more likely to kill their child via physical abuse, while mothers kill by neglect (for example, starvation). What is known about the perpetrators of child abuse? Over 75% of inflicted abuse is a result of parental action. Parental risk factors include young or single parents, those who did not graduate from high school, and those who either were abused themselves as children or endured a severely dysfunctional home life. Adults using drugs, abusing alcohol, and those with psychiatric disease (for example, depression, impulse-control disorders) are more likely to abuse children. Females account for 61% of perpetrators. A common theme when interviewing abusive individuals is an unrealistic expectation of infant or child behaviors. Often they expect developmental-milestone maturity beyond the age of the child (such as toilet training). Commonly, the child is incapable of providing what many parents anticipate to be unconditional love. The normally self-centered nature of childhood behavior clashes with the abusive adult's expectations with disastrous results. Who abuses children? According to the statistics, the majority of perpetrators of child mistreatment (77%) are parents and another 11% are other relatives of the victim. People who are in other caretaking relationships to the victim (for example, child-care providers, foster parents, and facility staff) account for only 2% of the offenders. About 10% of all perpetrators are classified as non-caretakers or unknown. In many states, child abusers by definition must be in a caretaking role. An estimated 81% of all offenders are under age 40. Overall, approximately 61% of perpetrators are female, although the gender of the abuser differs by the type of mistreatment. Neglect and medical neglect are most often attributed to female caretakers, while sexual abuse is most often associated with male offenders. What is child abuse? Four broad categories are generally recognized: 1. neglect (63%); 2. physical abuse (16%); 3. sexual abuse (10%) and; 4. emotional abuse (7%) (2005). What does the term child neglect include? Child neglect is the most frequently reported form of child abuse (63% of all cases) and the most lethal. Neglect is defined as the failure to provide for the shelter, safety, supervision, and nutritional needs of the child. Child neglect may be physical, educational, or emotional. The assessment of child neglect requires the consideration of cultural values and standards of care as well as the recognition that the failure to provide the necessities of life may be related to poverty. Physical neglect includes the refusal or delay in seeking health care, abandonment, inadequate supervision, expulsion from the home, or refusal to allow a runaway to return home. Educational neglect includes the allowance of chronic truancy, failure to enroll a child of mandatory school age in school, and failure to attend to a special educational need. Emotional neglect involves a marked inattention to the child's needs for affection, refusal of or failure to provide needed psychological care, spousal abuse or parental substance abuse in the child's presence, and permission of drug or alcohol use by the child. What actions are viewed as physical child abuse? Physical abuse is the second most frequently reported form of child abuse (16% of all cases). This form of mistreatment is defined as willful (as opposed to accidental) physical injury inflicted upon the child. Physical abuse can be the result of punching, beating, kicking, biting, burning, shaking, or otherwise harming the child's body. The parent or caretaker may not have intended to hurt the child; rather, the injury may have resulted from excessive disciplinary efforts or physical punishment. There exists a significant controversy regarding physical methods of discipline (for example, spanking) and their relationship to more orthodox forms of physical abuse. A unique form of physical child abuse is Munchausen syndrome by proxy. In this situation, a parent will purposely either invent symptoms and falsify records (for example, fever) resulting in unnecessary tests, hospitalizations, and even surgical procedures. This psychiatric illness of the parent(s) requires a high index of suspicion, and its consideration is part of the investigation of any child with recurrent complaints that are not supported by physical or laboratory findings. What constitutes emotional child abuse? Isolated emotional abuse is the least frequently reported form of child abuse (7% of all cases). This form is felt to be markedly underreported since it can be difficult to detect and document. However, since it is a component of all forms of child abuse, it is the most pervasive of all the previously listed forms of child abuse. There are several categories of emotional abuse and they may occur as unique experiences or together in the same child. They include 1. rejecting (for example, refusing to acknowledge the child's worth and emotional needs), 2. isolation (denying the child social experiences: locking child in the closet is an extreme example), 3. terrorizing (verbal assault with or without weapons), 4. ignoring (refusing to show affection), 5. corrupting (reinforcing destructive, antisocial, or sexually exploitative behaviors), 6. verbal assault (extreme sarcasm, name calling, public humiliation), and 7. over-pressuring (criticism of age-appropriate behaviors/skills as inadequate). Emotional child abuse is also sometimes termed psychological child abuse, verbal child abuse, or mental injury of a child. What is sexual child abuse? Sexual abuse is the third most frequently reported form of child mistreatment (10% of all cases). Experts believe that sexual abuse may be the most underreported type of abuse because of the secrecy or "conspiracy of silence" that so often characterizes these cases. A generally accepted definition of sexual abuse is that of a child involved in sexual activity for which consent cannot be given, is outside of the victim's developmental age, is unable to comprehend, and/or "violates the law or social taboos of society." Examples include fondling and any form of genital, anal, or oral-genital contact with a child that are unwarranted. These acts may occur whether the child is clothed or unclothed. Non-touching child sexual abuse would include exhibitionism, voyeurism, and the involvement of a child in prostitution or pornography. What causes child abuse deaths? The most lethal form of child abuse is neglect. Deaths from neglect can, for example, be caused by accidents due to lack of supervision or abandonment or from the failure to seek medical attention for an injury, illness, or condition. Fatal injuries from mistreatment can and do result from many different acts. Children may die from severe head trauma (injury), shaken baby syndrome, trauma to the abdomen or chest, scalding, burns, drowning, suffocation, poisoning, starvation, etc. What factors predispose a person to child abuse? Specialists evaluating an abused child's environment and family background have noted several risk factors for potential abuse: 1. The abuser's childhood: Approximately 20% of offenders were themselves abused as children. 2. The abuser's substance abuse: Children in alcohol-abusing families are nearly four times more likely to be mistreated, almost five times more likely to be physically neglected, and 10 times more likely to be emotionally neglected than children in non-alcohol-abusing families. Of all child-abuse cases, 50%-80% involve some degree of substance abuse by the child's parents. 3. Family stress: The disintegration of the nuclear family and its inherent support systems have been held to be associated with child abuse. 4. Social forces: Experts debate whether a presumed reduction in religious/moral values coupled with an increase in the depiction of violence by the entertainment and informational media may increase child abuse. 5. The child: Children at higher risk for abuse include infants who are felt to be "overly fussy," handicapped children, and children with chronic diseases. Specific "trigger" events that occur just before many fatal parental assaults on infants and young children include an infant's inconsolable crying, feeding difficulties, a toddler's failed toilet training, and exaggerated parental perceptions of acts of "disobedience" by the child. How is alleged child abuse evaluated? A thorough nonjudgmental history of the immediate events as well as a review of past similar experiences are often independently done by a physician, social worker, and/or the police department. The child may be interviewed separately from the parents as part of this information-gathering process. A complete physical exam of the child (which may include the taking of photographs to document physical/sexual abuse) is often followed by radiologic studies (x-rays, CT and MRI scans) and/or laboratory tests to support the potential diagnosis of inflicted trauma and to rule out the possibility of medical conditions which could account for the physical findings noted during the examination. A complete eye examination is indicated in all infants to evaluate to possibility of retinal hemorrhages associated with the shaken baby syndrome. How is child abuse treated? Steps which are often taken to correct child abuse are as follows: * The safety of the abused child and any other potential victim of abuse in the household is paramount. Removal of the victim and placement in protective custody in a group home or foster care is often necessary. * Effective counseling for the child, family, and the abuser is essential to deal with the associated emotional and psychological stress and trauma. * In the event of neglect, establishing realistic expectations of the child's needs and capabilities is required. * Parental high-risk behaviors such as substance/alcohol abuse must be addressed. * Law-enforcement evaluation is performed, followed by the filing of charges, court appearance, and (if found guilty) sentencing as indicated. * Pedophiles (people who have sexually abused children) often require intense psychological and pharmacological therapy prior to release into the community because of the high rate of repeat offenders. How can child abuse be prevented? This, too, is a very complex matter and includes these measures: * A support-group structure is needed to reinforce parenting skills and closely monitor the child's well-being. * Visiting home nurse or social-worker visits are also required to observe and evaluate the progress of the child and his/her caretaking situation. * The support-group structure and visiting home nurse or social-worker visits are not mutually exclusive. Many studies have demonstrated that the two measures must be coupled together for the best possible outcome. * Children's school programs regarding "good touch...bad touch" can provide children with a forum in which to role-play and learn to avoid potentially harmful scenarios. * Parents should make sure that their child's daycare center is licensed and has an open-door policy regarding parental visitation. * Public-awareness programs regarding child abuse and neglect can be informative. * Developing free and anonymous support systems (for example, "hot lines") encourages the reporting of potential instances of child abuse. What more can be done to prevent child neglect? As children's advocates, we wish to remind parents about the importance of preventative child health care, including: * proper use of car seats and seat belts; * consistent use of helmets for bicycling, skateboarding, and skiing/snowboarding; * pool and water safety; * firearm safety; * preventing community violence; and * poisoning prevention. http://www.cincinnatichildrens.org/svc/alpha/c/child-abuse/faq/detect.htm http://www.ocfs.state.ny.us/main/prevention/faqs.asp http://www.medicinenet.com/child_abuse/article.htm |