Signs

1
Signs Symptoms of Child Maltreatment

• Presented by
• The Child Abuse Neglect Prevention Program
• Charles County Department of Health

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History of Program

• Developed as pilot program
• Purpose
• Resource
• Education
• Training
• Materials
• Consultation
• Target population
• MDT

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Categories

• 4 categories of child maltreatment
• Physical Abuse
• Sexual Abuse
• Emotional Abuse
• Neglect

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Physical Abuse

• Physical injury inflicted on a child by other
  than accidental means.
• Severe or frequent bruising
• Burns
• Shaken Baby Syndrome
• Sudden Infant Death Syndrome
• Internal injuries
• Lacerations
• Fractures

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Location of Typical Abuse Related Physical
Injuries
Typical
Abuse-Related
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• Accidental vs. Intentional
• Injuries
• Location pattern- are two characteristics that
  separate accidental from abusive injuries
• Discipline becomes child abuse when serious
  bodily injury is inflicted or the child is
  exposed to risk of serious bodily injury

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• Bruises
• Bruises on uncommonly injured parts of body
• Blunt-instrument marks
• Human hand marks
• Multiple bruises at different stages of healing
• Shape or pattern (belt buckles, cord loops)
• Boxing- bruising of ear

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Burns

• Degree first, second, third, fourth
• Spill/splash
• Hot liquid that falls or splashes on victim is
  characterized by an irregular margin pattern
  depth
• Worst area of injury is on highest point of
  contact with body (e.g. chest). As liquid cools
  the burn depth lessens as it descends down the
  body

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• Contact burns
• contact with a heat source brands the pattern of
  object
• Accidental burns lack distinct pattern b/c child
  moves away
• Pay attention to area of body burned

10

• Immersion Burns
• Result from fall or placement into tub of hot
  liquid
• Deliberate immersion results in defined
  waterline b/w injured uninjured skin suggestive
  of being held in place
• Doughnut pattern to buttocks
• Stocking or glove burn patterns to hands/feet

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Shaken Baby Syndrome (SBS)

• Form of child abuse that occurs when an infant or
  young child is violently shaken
• Symptoms include swelling of brain, bleeding in
  eye, change in level of consciousness, seizures,
  vomiting, poor appetite gt development regresses
• These symptoms do not result from other types of
  accidents i.e. car accidents, roughhousing,
  falls
• Abuse results from babys incessant crying,
  illness, or irritability

12
Sudden Infant Death Syndrome (SIDS)

• The sudden death of an infant under a year
• Can happen to a seemingly healthy infant
• A death associated w/ sleep little or no signs
  of suffering
• Determined only after an autopsy, an examination
  of the death scene, review of the familys
  clinical histories provide no other cause of
  death

13

• Conditions Mistaken for Abuse
• Mongolian Spots vs. Bruises
• Occurs in majority of Africans, Asians
• Multiple areas of body
• Uniform in color, no swelling
• Seen at birth, persist variable time
• Folk Medicine Practices
• Coining or Cupping
• Severe Diaper Rash
• Nursemaids Elbow
• Occurs in ages 1-4 yrs.

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• Behavioral Signs of Physical Abuse
• Overdress for the weather
• Reluctant to change clothes
• Fearful of parents or adults
• Complains of pain
• Delay in seeking medical care

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Sexual Abuse

• Sexual intercourse, sexual contact, sexual
  exploitation, forced viewing of or listening to
  sexual activity engaging a child in
  prostitution.

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• Facts
• 1 out of every 3 American females will be a
  victim of sexual abuse by age 18 years.
• Females are most often abused by someone in their
  home/family.
• 1 out of every 6 American males will be a victim
  of sexual abuse by age 16 years.
• Males are most often abused by someone close to
  them outside of the home.

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• Physical Signs of Sexual Abuse
• Genital pain, swelling, itching
• Genital bruises, bleeding discharge
• Difficulty walking, sitting, frequent urination

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• Behavioral Signs of Sexual Abuse
• Compulsive masturbation
• Bed-wetting, soiling
• Excessive curiosity about sex or acting out
• Separation anxiety, fears, phobias

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Emotional Abuse

• Emotional damage for which the childs caretaker
  has neglected, refused or been unable for reasons
  other than poverty to obtain necessary treatment
  or take necessary steps to ameliorate the
  symptoms.

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• Facts
• A pattern of behavior
• Systematic tearing down of another human being
• Most prevalent form of abuse
• Infants who are deprived of emotional nurturing
  can fail to thrive and die or are slow to develop
  and grow into anxious and insecure children

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• Types of Emotional Abuse
• Rejection
• Ignoring
• Terrorizing
• Isolation
• Corruption

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• Behavioral Signs of Emotional Abuse
• Poor self image
• Inability to trust
• Aggressive, disruptive, angry
• Self destructive, self abusive
• Passive, clingy
• Fearful
• Depressed

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Neglect

• Failure, refusal or inability of a caretaker, for
  reasons other than poverty, to provide necessary
  care, food, clothing, medical or dental care or
  shelter so as to seriously endanger the physical
  health of the child.

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• Neglect
• Is what a parent doesn't do
• Is a pattern of behavior
• Types
• Physical
• Educational
• Emotional
• Lack of supervision/abandonment
• Medical
• Failure to thrive, malnutrition

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• Behavioral Signs of Neglect
• Steals
• Lacks medical or dental care
• Is consistently dirty and has body odor
• Consistently is inappropriately dressed for
  weather

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• Reporting

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Mandatory Reporting Law5-704/705Maryland
Family Law

• Any person, acting in a professional capacity who
  has reason to believe that a child has been
  subject to abuse or neglect shall notify social
  services or law enforcement.

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• Child means any individual under 18 years of
  age.

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• Mandated reporters include health practitioners,
  police officers, human service workers,
  educators.
• Educators include
• Teachers
• Counselors
• Social workers
• Case workers
• Probation or parole officers

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Penalties

• According to the law mandated reporters who
  knowingly fail to make a required report of
  suspected child abuse may be subjected to certain
  sanctions.
• These sanctions include the denial, suspension or
  revocation of a license, as well as reprimand or
  probation.

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• A report requires only reasonable suspicion,
• NOT proof.
• Pay attention to your instincts!

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• Reporters are protected, as long as they act in
  good faith.

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Immunity5-708

• Provides immunity from civil liability or
  criminal penalty to anyone who in good faith
  makes a report of suspected child abuse or
  neglect or participates in an investigation, or
  in any judicial proceeding resulting from the
  report.

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Confidentiality

• The name of the reporter may only be revealed
  under a court order.

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WHAT DO I DO WHEN I SUSPECT ABUSE?

• Remember that you are not investigators
• Call CPS
• Let CPS sort things out and provide the necessary
  help.
• Stay non-judgmental
• Avoid assuming details
• Assess need for medical care

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WHAT DO I DO WHEN A CHILD DISCLOSES?

• do
• Stay calm
• Listen
• Do not project or assume anything
• Remain non-judgmental
• Be supportive, Say, Im glad you told me.
• Tell the child that you will get help

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• Do not
• Interrogate
• Promise to keep a secret
• Tell the child that youll make sure it never
  happens again
• Assure the child he/she will be just fine
• Say things like, Were going to get this
  ?_at_...
• Show
• Anger
• Disbelief
• Disgust
• Dread
• Confusion

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REMEMBER

• Child maltreatment doesnt happen just once.
• By helping one victim you may be helping other
  victims.

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?Questions?

• Contacts
• Lois Beverage, RN, BSN
• Program Manager
• 301-609-6803
• Nicole Mathews, MS
• Coordinator
• 301-609-6833