- 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.
As a support staff member, your job includes doing your best to make the program a great place for you, your coworkers, and the children and families served. Because the children in your center depend on adults for their safety, this also means you must do your best every day to keep children safe. For this, you must be able to recognize when a child is in harm’s way.
The threat of abuse or neglect can be present at home, at school, or in child care programs. Because of this, children should be surrounded by a network of caring adults who are aware of the signs of abuse and neglect and will quickly respond to help the child. 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- Is overly compliant, passive, or withdrawn (doesn’t respond to situations that seem to warrant a response)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 pickup or drop off
- Is dropped off at your program early, stays late, or does not want to go home
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 pickup 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 the physical and behavioral signs of 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 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, you 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, ask a family member about the injury. This shows that all program staff members, regardless of role, 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 all. How did it happen?”
- Make sure it’s an OK time to talk and be prepared to get help if the family needs it. For example, if you overheard a parent speaking harshly to a child as they entered the building, you might say to the parent, “I overheard you talking to Geri, you seemed pretty frustrated. Do you have a minute to talk?”
- 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 can do here at the program 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, you are delivering lunches to the classrooms and as you are talking with the children, one child tells you the scratches on her face came from falling into a bush. When the child’s teacher talks 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 all over 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.
Risk 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 victims 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
Risk for School-Age Children: Internet Predators and Cyber-Bullying
Abuse can occur by family members or other adults that children are in regular contact with as well as online by adults they have never met. 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. Unfortunately, the anonymous nature of the internet means that some of these contacts might be predatory adults. With personal devices, online communication is always open. Because of this, even though you may not directly care for children, you might be the closest adult to a child when they receive an inappropriate picture or a message that makes them feel uncomfortable.
All program staff must be on the lookout for signs that a child is engaged in dangerous or inappropriate relationships online. Make sure that you remind children of smart internet use guidelines when you see them on a device. To keep children safe, make sure you:
- Remind children never to meet a person they only know online.
- Discuss boundaries related to sharing images and content.
- Make sure that children feel safe talking to an adult if they receive inappropriate content from another child or an adult or are asked to share inappropriate content or images of themselves.
- Be aware of how you and your coworkers use your phones during program hours and make sure you are following the rules your program has put forth.
- To maintain firm boundaries, check your account privacy settings and avoid interacting with children in your program online.
All staff, regardless of role, must 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. Again, since internet-connected devices like phones allow communication to happen at any time, you may be the closest adult to a child when they receive an abusive message and need to talk. Observe for the signs of emotional abuse that you will read about later in the lesson.
Risk for School-Age Children: 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 other staff members. As a support staff member, you must remain alert to these situations and know how to respond to them appropriately. You should always act within the boundaries of the program’s Guidance and Touch Policy and know how to respond if an older child does something that makes you uncomfortable, such as sitting on your lap, squeezing in next to you on the couch, grabbing your hand or asking personal questions. If you feel unsure of how to respond in these situations, talk to your program manager. While it can feel dismissive to turn away a child or establish a boundary, it is important to remember that you are protecting yourself from accusation and ensuring the child grows in a developmentally appropriate way. If a child asks you questions that demonstrate advanced sexual knowledge, this may qualify as reasonable suspicion of abuse and lead to you filing a report with Child Protective Services (CPS). FAP, CPS, and law enforcement. Avoid being alone with a child and never share images, videos, jokes, or content that are sexual or romantic in nature.
Remember that the young children and preteens that are a part of your program are children, and although they 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. Download and print the attachment in the Apply section for a complete list. 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 the 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.
A Resonable Suspicion of Child Abuse or Neglect
It is not uncommon to question yourself when you suspect child abuse or neglect. In many ways, this is human nature: we want to see the best in families and coworkers. Unfortunately, doubting yourself about suspicions of child abuse or neglect can be dangerous. Something that can make this process easier is remembering that the signs listed above constitute a reasonable suspicion.
A suspicion is a belief that something is wrong. It is an inkling or a feeling, based on observation or experience, that a child is being mistreated. You do not need to prove that child abuse or neglect is occurring. You do not need to investigate. You do not even need to know who the suspected abuser is. If you think a child has been harmed, is in danger of being harmed, or have noticed any of the behavioral indicators or signs above, your suspicion of child abuse or neglect is reasonable and should be reported immediately.
Remember that every employee of the child development program is a mandated reporter of child abuse and neglect. Each staff member has a legal and ethical obligation to report suspicions of child abuse and neglect and can face penalties for failing to do so. The first step in meeting your obligation is recognizing when a child has been harmed or is in imminent risk of harm. Learning to recognize the signs of abuse and neglect is important, regardless of your role.
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 after common injuries, like falls on the playground.
- 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 CPS 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 program and their families, regardless of your role. 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 at every opportunity.
- 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.
- Learn about the cultures of the children in your program. Some cultures have rituals or healing practices that might be mistaken for signs of abuse. Ask your program 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, educator Kenneth R. Lafontaine (1999) suggests doing the following:
- Listen. 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. 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.
Brown, C. H. (2014). The Strengthening Families Approach and Protective Factors Framework: Branching Out and Reaching Deeper. Washington, D.C.: Center for the Study of Social Policy. Retrieved from https://cssp.org/resource/the-strengthening-families-approach-and-protective-factors-framework-branching-out-and-reaching-deeper/
Centers for Disease Control and Prevention. (2016). Violence Prevention. Retrieved from http://www.cdc.gov/violenceprevention/
Center for the Study of Social Policy. (2019). Strengthening Families: A Protective Factors Framework. Retrieved from https://cssp.org/resource/about-strengthening-families-and-the-protective-factors-framework/
Child Welfare Information Gateway. (2012). Mandatory Reporters of Child Abuse and Neglect. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.
Child Welfare Information Gateway. (2012). Penalties for Failure to Report and False Reporting of Child Abuse and Neglect. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.
Lafontaine, Kenneth R. (1999). Recognizing Child Abuse and Neglect Fact Sheet. Columbus, Ohio: Ohio State University.
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. (2006). The Prevalence of Child Abuse and Neglect. Retrieved from https://www.zerotothree.org/resources/91-the-prevalence-of-child-abuse-and-neglect