- Identify the signs and behavioral indicators of child abuse and neglect for infants and toddlers, preschoolers, and school-agers.
- Identify examples of behaviors that might indicate familial and institutional abuse.
- Observe children for signs of abuse and neglect.
We all want to keep children safe. To do so, we must be able to recognize when a child is in harm’s way. Look for the following signs from the Child Welfare Information Gateway fact sheet on child abuse and neglect from the U.S. Department of Health and Human Services.
Abuse or neglect may be suspected if the child:
- Shows sudden changes in behavior, changes that seem like regression (losing skills they once had, crying more, etc.), or changes in school performance
- Has not received help for physical or medical problems brought to the parents’ attention
- Is always watchful, as though preparing for something bad to happen
- Lacks adult supervision
- Is overly compliant, passive, or withdrawn (doesn’t respond to situations that seem to warrant a response)
- Has little reaction to parents at pick up or drop off
- Is dropped off at your program early, stays late, or does not want to go home
- Has learning problems (or difficulty concentrating) that cannot be attributed to specific physical or psychological issues
Or if the parent:
- Shows little concern for the child
- Denies the existence of—or blames the child for—the child's problems in your program or at home
- Asks caregivers to use harsh physical discipline if the child misbehaves
- Sees the child as entirely bad, worthless, or burdensome
- Demands a level of physical or cognitive performance the child cannot achieve
- Looks primarily to the child for care, attention, and satisfaction of emotional needs
Or if the parent and child:
- Rarely touch or look at each other
- Do not respond to each other after a separation (such as at pick-up time)
- State that they do not like each other
- Consider their relationship entirely negative
It’s not always easy to recognize child abuse and neglect. Remember that any one of these signs by itself does not necessarily mean a child has been abused or neglected. Often a pattern or combination of behaviors may lead to the suspicion that a child is experiencing abuse or neglect. Watch this video to learn about recognizing abuse and neglect.
Asking Questions and Opening the Lines of Communication
All children get hurt occasionally: Bumps, bruises, and scrapes can be signs of healthy and active exploration. Sometimes, more serious accidents happen as well: A child pulls a cup of hot tea down on herself, or breaks a bone playing a sport, or a child is involved in a car accident. Sometimes, a medical condition causes symptoms that mimic abuse. For example, some skin conditions can leave marks that look like bruises or scars. To be most effective at protecting children from child abuse and neglect, we must be able to differentiate between accidents and abuse. Conversations are a powerful tool for doing so. Whenever you notice an injury or symptom in a child, complete an incident or accident report and ask about the injury. This is a standard part of caregiving and shows you take an interest in the child’s well-being. Remember, you are not investigating the injury. You are simply doing what comes naturally when someone is hurt: asking what happened and how the person is doing. Here are some tips for asking questions:
- Ask open-ended questions. You might say, “Ouch. That looks like it hurts. What happened?”
- Show concern and empathy: “I bet that was pretty scary for you guys. How did it happen?”
- Make sure it’s an OK time to talk, and be prepared to get help if the family needs it. “Is it OK to ask you about Geri’s bruises? Do you have a minute?”
- Find out if there is anything else you should know about the injuries. “I’m glad you took her to the doctor. Is there anything we should do to make her comfortable during the day? Or is there anything she shouldn’t do?”
In most cases the family member will give you a clear and accurate account of what happened. For older toddlers, preschoolers or school-age children, you can also ask the child what happened. You might suspect child abuse or neglect if:
- The child’s answer and the adult’s answers do not match or if two different adults give conflicting stories about how the injury happened. For example, a child tells you the scratches on her face came from falling into a bush. When you talk to her dad later, he says she got them from a child at a birthday party.
- The story does not seem consistent with the child’s developmental level. For example, you might suspect abuse if a parent says a 4-month-old climbed out of a crib and got hurt.
- The story is not consistent with the injuries. For example, a child has burn marks on his hands that look almost like gloves—his hands were clearly submerged in something hot. His mother says the child accidentally grabbed a pot off the stove. Accidental burn injuries usually show some kind of splatter patterns as the child pulls away.
Risks for Infants:
Shaken Baby Syndrome
Shaken baby syndrome is a form of head trauma and brain injury. It can be caused by someone violently shaking, dropping, or throwing an infant. Most victims of shaken baby syndrome are under the age of 1, with the average age of victim being between 3 and 8 months. When babies are shaken, their neck muscles are not strong enough to control their heads. This causes the brain to move back and forth inside the skull. The result is bleeding and bruising of the brain. The effects are even worse when the shaking ends with a sudden impact, as when a child is slammed into a crib or against a wall.
Look for the following symptoms of shaken baby syndrome. Remember, any one sign alone is not definitive evidence of abuse. Look for a combination of the following:
- Altered consciousness
- An inability to focus the eyes or track movement
- An inability to lift the head
- Decreased alertness
- Difficulty breathing
- Extreme irritability
- Lack of smiling or vocalizing
- Pale or bluish skin
- Poor feeding
- Problems sucking or swallowing
- Unequal pupil size
Risks for School-Age Children:
Internet Predators and Cyber-Bullying
School-age children are growing up in a world of online social networks. They may have access to sites where they have “friends” they have never actually met. You must be on the lookout for signs that a child is engaged in dangerous or inappropriate relationships online. You will learn more about this in the Safe Environments lesson. Make sure that you monitor children’s Internet usage, and make sure they know never to meet a person they only know online. To keep children safe, make sure you:
- Can always see the monitors when children are on computers
- Check browser histories, apps on tablets and smartphones
- Install software that blocks questionable content
- Talk to school-age children about safe Internet use
You must also be on the lookout for children who are being victimized online. This victimization can come from other children, but it can also come from adults. There have been several high-profile cases of children being taunted, harassed, belittled, and insulted online. Sometimes, these stories come to light after the child commits suicide. Many victims are under the age of 12. Observe for the signs of emotional abuse that you will read about later in the lesson.
Crushes and Predatory Relationships
Later in the school-age period, children may begin to show an interest in sex and romantic relationships. It’s not unusual for children to have boyfriends and girlfriends. It’s also not unusual for school-age children to have crushes on teachers, coaches, or care providers. As a family child care provider, you must remain alert for these situations and handle them gracefully and appropriately. You will learn about a Guidance and Touch Policy later in this course. Be sure that you always act within the boundaries of that policy. Learn how to respond if an older child does something that makes you uncomfortable: sits on your lap, squeezes in next to you on the couch, or grabs your hand.
Remember that you are working with young children and preteens. Although the child might have a crush, sexual activity or sexual touching is never consensual. If you suspect that a child is being sexually abused by another adult or teen, you must make a report. You will learn about reporting procedures in the next lesson.
The following are signs often associated with particular types of child abuse and neglect. It is important to note that these types of abuse are more typically found in combination than alone. A physically abused child, for example, is often emotionally abused as well, and a sexually abused child also may be neglected. Remember to remain aware of two kinds of abuse: familial and institutional. The signs and behavioral indicators you see in children may be similar for each.
You might see an infant that:
- Is always watchful, passive, or immobile but intently observing as if fearful
- Has bruises but is not yet standing or walking
- Has burns with clear lines of demarcation and no or few splash marks, often on the buttocks or feet and heels (accidental burns usually have splash marks as the child rapidly withdraws from the heat)
- Has burns that take the shape of a recognizable object (cigarette, curling iron)
- Has human bite marks
- Has mouth injuries from forcing a spoon or object into the mouth or forcing a bottle out of the mouth
- Has signs of severe head injuries: decreased consciousness, seizures, vomiting, altered mental status, or an unusual cry
You might see an toddler or 2-year-old that:
- Shows signs listed above
- Has bruises that take the shape of a recognizable object
- Has injuries to the side of the face, cheeks, or ears
- Shrinks at the approach of familiar adults
- Shows extreme behaviors like being very withdrawn or crying much more than is typical
You might see preschool or school-age child that:
- Has unexplained burns, bites, bruises, broken bones, or black eyes
- Has fading bruises or other marks noticeable after an absence from the program
- Seems frightened of the parents and protests or cries when it is time to go home
- Shrinks at the approach of adults
- Reports injury by a parent or another adult caregiver
You might see a parent or adult that:
- Uses harsh physical punishment
- Offers conflicting, unconvincing, or no explanation for an injury
- Describes the child as “evil” or “bad,” or in some other very negative way
Examples of Familial Physical Abuse:
- During a diaper change for a 6-month-old baby, a caregiver notices purple, brown, and yellow bruises on her inner thighs and buttocks. The baby’s father says she fell from the crib with the rails up. The caregiver knows the baby does not yet pull up or climb.
- A 2-month-old infant is dropped off in the morning. The caregiver notices right away that his eyes aren’t focusing and he doesn’t seem like herself.
- Jordyn has circular burn marks up and down her thighs. They are size and shape of a cigarette.
- A child has bite marks on his arm. When you ask what happens, he says, "I bit my brother, so mom bit me back.”
Examples of Institutional Physical Abuse…
- A member of your household, who sometimes assists you, has had a very hard day. Fiona, 18 months, has been crying and throwing herself on the floor for ten minutes. It’s time to get the kids outside. In frustration, a member of your household grabs Fiona by the top of the arm and yanks her up to walk. She squeezes so hard that Fiona has bruises around her upper arm in the shape of a hand.
- You are visiting the park with a fellow family child care provider and the children in her program. Robert, a child in her program, has been using severe challenging behavior lately. Your fellow family child care provider says, "I'll take care of this. I know his mom and she would not want him to get away with this," and takes Robert around the side of the park’s recreation building out of sight. When they come back, Robert is crying and holding his backside.
You might see a child that:
- Has abdominal pain or pain urinating
- Has genital bleeding, pain, or inflammation
- Shows sudden changes in behavior
- Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior
- Has difficulty walking or sitting
- Suddenly refuses to change clothes or to participate in physical activities
- Reports nightmares or bedwetting
- Experiences a sudden change in appetite
- Runs away
- Reports sexual abuse by a parent or another adult caregiver
You might see a parent or adult that:
- Is unduly protective of the child or severely limits the child's contact with other children, especially of the opposite sex
- Is secretive and isolated
- Is jealous or controlling with family members
Signs of Possible Familial Sexual Abuse:
- A 2-year-old girl sits and plays with dolls. She touches the genital area and says, “It hurts, but it’s OK.”
- You see Candice lying on top of a boy in the dramatic play center. She is clearly making sexual movements and seems to have a very accurate knowledge of sexual behavior.
- Amelia's 19-year-old brother is coming to pick her up today. She tells you she loves her brother and they have "secrets" in her room at night.
Signs of Possible Institutional Sexual Abuse:
- An assistant offers to take Jerusha inside for a diaper change. Jerusha screams, “No” and hides behind you. “No hurt,” she screams.
- A provider has a “favorite” child. She often forces him to snuggle, sit on her lap, and be held when he does not want to be. She “massages” him in a sexual way.
- An assistant has sexual pictures of a child on his or her phone.
- A child tells you Mr. Jay's "pee-pee is bigger than mine."
You might see a child that…
- Seems indifferent or unattached to the parent
- Calls himself “bad”
- Shows extremes in behavior, such as being overly compliant or demanding or demonstrating extreme passivity or aggression
- Is either inappropriately adult (parenting other children, for example) or inappropriately infantile (frequently rocking or head-banging, for example)
- Is delayed in physical or emotional development
You might see a parent or adult that…
- Ignores signs the child wants affection or nurturance
- Ignores the child or fails to provide necessary stimulation
- Pressures the child to “grow up” or perform beyond his or her developmental level
- Constantly blames, belittles, or berates the child
- Is unconcerned about the child and refuses to consider offers of help for the child's problems
- Overtly rejects the child
Examples of Familial Emotional Abuse…
- A mother tells her toddler, “Be good today, or I won’t pick you up this afternoon.”
- A parent ignores an infant’s screams for a period of time and then yells at him to “Shut up!”
- A father comes to pick Dora up from the program. He tells her to stop being "slow and stupid like her mom."
- A 5-year-old says there is nothing he likes to do with his parents and ignores them when they arrive at the program.
Examples of Institutional Emotional Abuse…
- A provider belittles a toddler by saying, “Even those babies over there can climb the slide. What’s wrong with you?”
- A provider joins in when children begin ridiculing another child's body size. She calls the child "fat and lazy."
- A provider forces a child to stay in his soiled clothes after a toileting accident so he "learns a lesson."
You might see a child that…
- Is frequently absent
- Begs or steals food or money
- Lacks needed medical or dental care, immunizations, or glasses
- Is consistently dirty and has severe body odor
- Lacks sufficient clothing for the weather
- States that there is no one at home to provide care
You might see a parent or adult that…
- Appears to be indifferent to the child
- Seems apathetic or depressed
- Behaves irrationally or in a bizarre manner
- Is abusing alcohol or other drugs
Examples of Familial Neglect…
- A father drops his child off every day with a diaper that clearly has not been changed since the previous afternoon. The child’s diaper rash is quite severe, and parents have not responded to requests for medication.
- 4-year-old Marjorie tells you her 6-year-old sister had to make dinner for her last night. No other adults were in the home.
- Zach's mom has not brought in a replacement for his empty rescue inhaler. Zach has severe asthma and needs the medication.
Examples of Institutional Neglect…
- A provider walks out of the room and leaves the children alone for longer than a few minutes for personal needs or without assuring children’s safety before taking a restroom break.
Recognizing Child Abuse and Neglect in Family Child Care
Caring for children can be a stressful job. There can be a fine line between inappropriate caregiving practices and child abuse. When in doubt, talk with your coach. In the course on Preventing Child Abuse in Family Care Settings, you will learn more about positive guidance and discipline strategies. Sometimes, discipline practices cross the line into maltreatment and even abuse. You will learn more about that in the next course. This lesson focuses on clear examples of child abuse or neglect in child care settings. If you see any of these signs or behaviors, you should report the suspected child abuse or neglect:
|Signs of Abuse|
Common Conditions Mistaken for Abuse
There are several medical conditions that often bring about symptoms that could be mistaken for abuse. It is important to be aware of these conditions. But remember, you are not responsible for making medical diagnoses. If you have questions, ask the family or a community resource for support.
- Mongolian spots: These gray spots are present at birth and often look like bruises. They are usually found on the buttocks or lower back, but they can be found anywhere. They fade slowly over time.
- Blood or bleeding disorders: Some genetic conditions can cause severe bruising.
- Bone deficiencies or diseases: Some bone diseases cause bones to break easily.
Cultural Practices Mistaken for Abuse
Some cultures have rituals or healing practices that might be mistaken for signs of abuse. All suspected concerns of abuse should be immediately reported. It is not your job to determine whether something you see is a cultural practice or an instance of abuse. You should make a report and let Child Protective Services make that determination. This section is intended only to give you some basic information about customs that can be mistaken for child abuse. Two common examples are coining and cupping.
In coining, the chest, back, and shoulders are rubbed with a medicated ointment. Then a warmed copper coin is rubbed from the top of the shoulders down the back. Dark lines appear from the pressure and the heat. The marks, which look like long bruises, usually last for several days.
Cupping is a home-remedy used to relieve pain in the legs, back, chest, abdomen, or head. A small glass cup is held upside down and a candle is lighted inside it. The cup is quickly placed on the skin and a vacuum effect draws the skin up. A circular mark is left on the skin for several days. Often there is a series of cup marks along the affected area. Michael Phelps brought the practice to the forefront during the 2016 Olympics.
There are many other cultural practices that might be considered child abuse by state law. If you are unsure whether a mark is a sign of child abuse, it is always best to make a report. The appropriate authorities will make the determination.
There are steps you can take to make sure you can recognize instances of child abuse and neglect. Take the following steps:
- Get to know all of the children in your care and their families. You cannot recognize a problem if you don’t know what is typical for the child. Learn children’s patterns, temperaments, preferences, and abilities. Talk to families every day.
- Learn all you can about child development. Some changes in a child’s behavior can be startling—but completely typical. For example, it’s not unusual for toddlers to have bruises all over their legs or on their heads. Falling is a part of learning to walk and run! Young children may be scared of certain adults as part of typical stranger anxiety. Knowing these developmental stages can help you recognize when a child’s behavior goes beyond what is typically expected.
- Attend trainings on child abuse identification and reporting.
- Develop respectful communication skills. If you have a concern, ask about it. Ask open-ended questions that focus on the child’s well-being. “Is it OK if I ask you about Jordan’s bruises?” or “I’ve noticed that Tasha hasn’t seemed like herself lately. Is everything OK?” If something doesn’t seem right, gather as much information as you can.
- Keep careful records. Your daily health screening can be an important tool for identifying child abuse and neglect. Look for signs or behavioral indicators and write down what you see or hear. Write down adults’ explanations for injuries and children’s explanations (if applicable). If a pattern emerges, you will have ample evidence for making your report.
- Learn about the cultures of the children you serve. Some cultures have rituals or healing practices that might be mistaken for signs of abuse. Ask your family child care administrator, or local resource and referral agency for information if you need help. When in doubt, make a report. Child Protective Services will decide whether abuse has occurred.
- Learn reporting procedures for your state. You will learn more about this in the next lesson.
For older preschoolers and school age children:
Be prepared to recognize the signs of child abuse and neglect in school-age children. School-age children may become good at hiding physical signs of abuse and neglect. You might become suspicious because of something you hear. A child may also tell you that he or she is experiencing abuse or neglect. If a child tells you about abuse or neglect, according to educator Kenneth R. Lafontaine (1999):
- The child must voluntarily give information. Avoid asking leading questions like, “Did he abuse you?” or “Did she touch your private parts?” Many cases of child abuse and neglect have been unsubstantiated because the court decided the child’s testimony had been influenced by adults’ questions.
- Let the child know he or she is doing the right thing.
- Make it clear that abuse and neglect is not the child’s fault.
- Control your own emotions and remain calm.
- Do not promise not to tell. You cannot keep this promise. You must keep the child safe by making a report.
- Report the case immediately.
- Keep information confidential and only share information with those who have a need to know.
Learn more about the scenario that you read in Lesson One. This time, look for the signs of abuse and neglect. Then, answer the reflection questions. When you are finished, share your answers with your family child care administrator. Then, review the suggested responses for additional reflection on Kate’s story.
Read and review the fact sheet, Recognizing the Signs and Symptoms of Child Abuse and Neglect. Make sure you are familiar with its contents and can describe the signs of abuse and neglect that you might see.
|Familial abuse and neglect||Abuse or neglect committed by a parent, guardian, or member of the family|
|Institutional abuse and neglect||Abuse or neglect that takes place outside of the child’s home and is committed by someone in a supervisory role over the child (teacher, scout leader, etc.)|
|Neglect||Failure by a caregiver to provide needed, age-appropriate care although financially able to do so or offered financial or other means to do so (U.S. Department of Health and Human Services, 2007)|
|Physical abuse||Non-accidental trauma or injury|
|Sexual abuse||The involvement of a child in any sexual touching, depiction, or activity|
|Emotional abuse||A pattern of behavior by adults that seriously interferes with a child’s cognitive, emotional, psychological or social development|
|Guidance and touch policy||The policy your program has developed that describes the boundaries of acceptable and unacceptable discipline procedures and ways of touching children|
Center for the Study of Social Policy (2018). Strengthening Families: A Protective Factors Framework. Retrieved from https://cssp.org/resource/about-strengthening-families-and-the-protective-factors-framework/
Centers for Disease Control and Prevention (2013). Violence Prevention. Retrieved from http://www.cdc.gov/violenceprevention/
Centers for Disease Control and Prevention (2007). Preventing Child Sexual Abuse within Youth-Serving Organizations: Getting Started on Policies and Procedures. Retrieved from http://www.cdc.gov/violenceprevention/pdf/PreventingChildSexualAbuse-a.pdf
Lafontaine, K. R. (1999). Ohio State University Extension Fact Sheet: Recognizing Child Abuse and Neglect. Columbus, OH: State 4-H Office.
Military Family Advocacy Programs. Retrieved from http://www.militaryonesource.mil/abuse/service-providers
National Institutes of Health (2011). Shaken Baby Syndrome. Bethesda, MD: U.S. National Library of Medicine. Retrieved from https://medlineplus.gov/ency/article/007578.htm
Seibel, N. L., Britt, D., Gillespie, L. G., & Parlakian, R. (2006). Preventing Child Abuse and Neglect. Washington, DC: Zero to Three: Center for Infants, Toddlers and Families.
U.S. Department of Health and Human Services (n.d.). Stopbullying.gov: Cyberbullying. Retrieved from: https://www.stopbullying.gov/cyberbullying/what-is-it/index.html
Zero to Three: Center for Infants, Toddlers and Families (n.d.). Child Abuse and Neglect. Retrieved from https://www.zerotothree.org/resources/91-the-prevalence-of-child-abuse-and-neglect