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Continuing Education for Health Professionals

NY: Child Abuse and Maltreatment/Neglect for Mandated Reporters

Module 5

Indicators of Child Abuse or Maltreatment/Neglect

Indicators, or signs, of child abuse or maltreatment are alerts or warnings that you need to give more attention to a situation (CWIG, 2013a; NYSOCFS, 2016, 2011, n.d.; Monroe County, 2003).

The three types of indicators to consider are:

  • Physical indicators
  • Child’s behavioral indicators
  • Parent’s behavioral indicators

Sometimes a situation will be straightforward. For example, a baby born with a positive toxicology, a child with the handprint of a slap showing on their face, or a direct disclosure made by a child give clear support for reasonable cause to suspect. However, more often the situation will require that you pull together several indicators or clusters of indicators. The lists that follow identify many common indicators of possible abuse or maltreatment, but these should not be considered in isolation from the child’s current condition or circumstances (how they look and act). In addition, signs may sometimes appear contradictory (NYSOCFS, 2011).

Consider each of your unique experiences with children when you are assessing a situation. Sometimes you will have had regular interactions with a child and other times you will see a child only once. Consider what you know of the child and appropriate age and developmental norms. Keep in mind that children are individuals and will not necessarily react in the same way to a given situation (NYSOCFS, 2011).

Also, be aware of the parent or other legally responsible individual’s behavior. If the information you are getting suggests abuse or maltreatment, ask yourself the following questions: Is this explanation plausible? Is the person repeating gossip or speaking from personal knowledge? What specifically are they saying about the child’s condition or behavior? (NYSOCFS, 2011).

Never assume abuse or maltreatment. Conversely, many abused and maltreated children may not show any of these indicators (NYSOCFS, n.d.).

Physical Abuse

Child’s physical indicators

  • Unexplained bruises and welts
  • On face, lips, mouth
  • On torso, back, buttocks, thighs
  • In various states of healing
  • Clustered, forming regular patterns, reflecting shape of article used to inflict (electric cord, belt buckle)
  • On several different surface areas
  • Regularly appear after absence, weekend, or vacation

Unexplained burns

  • Cigar, cigarette burns, especially on soles, palms, back, and buttocks
  • Immersion burns (sock-like, glove-like, doughnut-shaped on buttocks or genitalia)
  • Patterned like electric burner, iron, et.
  • Rope burns on arms, legs, neck, or torso

Unexplained lacerations or abrasions

  • To mouth, lips, gums, eyes, ears
  • To external genitalia
  • On backs of arms, legs, or torso
  • Human bite marks
  • Frequent injuries that are “accidental” or unexplained

Child’s behavioral indicators

  • Wary of adult contact
  • Apprehensive when other children cry
  • Behavioral extremes: aggressiveness, withdrawal, changes in behavior
  • Frightened of parents
  • Afraid to go home
  • Reports injury by parents
  • Wears long-sleeved or similar clothing to hide injuries
  • Or conversely, inappropriate boundaries and affection seeking from any adult

Parent’s behavioral indicators

  • Seems unconcerned about child
  • Takes an unusual amount of time to obtain medical care for the child
  • Offers an inadequate or inappropriate explanation for the child’s injury
  • Gives different explanations for the same injury
  • Personal or partner abuse of alcohol or other drugs
  • Personal or partner history of mental illness; especially if inadequately treated
  • Disciplines the child too harshly considering the child’s age or what he/she did wrong
  • Describes the child as bad, evil, etc.
  • Has a personal history of abuse as a child

Frequent partner changes

  • Attempts to conceal the child’s injury
  • Takes the child to a different doctor or hospital for each injury
  • Has poor impulse control

Maltreatment/Neglect

Child’s physical indicators

  • Consistent hunger, poor hygiene, inappropriate dress
  • Consistent lack of supervision, especially in dangerous activities, for long periods, or overnight
  • Unattended physical problems or medical or dental needs
  • Abandonment

Child’s behavioral indicators

  • Begging or stealing food
  • Extended stays in school (early arrival and late departure)
  • Attendance at school infrequent
  • Constant fatigue, falling asleep in class
  • Alcohol and drug abuse
  • States there is no caretaker

Parent’s behavioral indicators

  • Misuses alcohol or other drugs
  • Has disorganized, upsetting home life
  • Is apathetic, feels nothing will change
  • Is isolated from friends, relatives, neighbors
  • Has long-term chronic illness
  • Cannot be found
  • Has history of neglect as a child
  • Exposes child to unsafe living conditions
  • Evidences limited intellectual capacity

Emotional Maltreatment

Child’s physical indicators

  • Conduct disorders (fighting in school, anti-social, destructive, etc.)
  • Habit disorders (rocking, biting, sucking fingers, etc.)
  • Neurotic disorders (tics, sleep problems, inhibition of play)
  • Psychoneurotic reactions (phobias, hysterical reactions, compulsion, hypochondria)
  • Lags in physical development
  • Failure to thrive

Child’s behavioral indicators

  • Overly adaptive behavior (inappropriately adult or inappropriately infantile)
  • Developmental delays (mental, emotional)
  • Extremes of behavior (compliant, passive, aggressive, demanding)
  • Suicide attempts or gestures, self-mutilation

Parent’s behavioral indicators

  • Treats children in the family unequally
  • Doesn’t seem to care much about child’s problems
  • Blames or belittles child
  • Is cold and rejecting
  • Inconsistent behavior toward child

Sexual Abuse

Child’s Physical Indicators

  • Difficulty in walking or sitting
  • Torn, stained, or bloody underclothing
  • Pain or itching in genital area
  • Pregnancy, especially in early adolescent years
  • Bruises or bleeding in external genital, vaginal, or anal areas
  • Sexually transmitted disease (especially in pre-adolescent age group), includes venereal oral infections

Child’s behavioral indicators

  • Unwilling to change for or participate in physical education class
  • Withdrawal, fantasy, or infantile behavior
  • Bizarre, sophisticated, or unusual sexual behavior or knowledge
  • Self-injurious behaviors, suicide attempts
  • Poor peer relationships
  • Aggressive or disruptive behavior, delinquency, running away, or school truancy
  • Reports sexual assault by caretaker
  • Exaggerated fear of closeness or physical contact

Parent’s behavioral indicators

  • Very protective or jealous of child
  • Encourages child to engage in prostitution or sexual acts in the presence of caretaker
  • Misuses alcohol or other drugs
  • Is geographically isolated and/or lacking in social and emotional contacts outside the family
  • Has low self-esteem
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