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    Objectives
    • Identify the signs and behavioral indicators of child abuse and neglect for infants and toddlers.
    • Identify examples of behaviors that might indicate familial and institutional abuse.
    • Observe children for signs of abuse and neglect.

    Learn

    Learn

    Know

    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 (U.S. Department of Health and Human Services).

    The child:

    • Shows sudden changes in behavior or changes that seem like regression (losing skills they once had, crying more, etc.)
    • 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    • Is overly compliant, passive, or withdrawn (doesn’t respond to situations that seem to warrant a response)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

    The parent:

    • Shows little concern for the child
    • Denies the existence of—or blames the child for—the child's problems in the 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

    The parent and child:

    • Rarely touch or look at each other
    • Do not respond to each other after a separation (i.e., at pick-up time)

    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.

    Recognizing Signs of Abuse and Neglect

    Learn about recognizing abuse and neglect

     

    Asking Questions and Opening the Lines of Communication

    All toddlers get hurt occasionally: bumps, bruises, and scrapes can be signs of healthy exploration. Sometimes, more serious accidents happen as well: a child pulls a cup of hot tea down on herself 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 infants and toddlers 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, 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 has scratches all over her face. At drop-off, her dad says she got them from a child at a birthday party. At pick-up, her mom says she got them from the family cat.
    • 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.

    Shaken Baby Syndrome

    Shaken baby syndrome is a form of head trauma and brain injury. It can be caused by 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
    • lethargy
    • pale or bluish skin
    • poor feeding
    • problems sucking or swallowing
    • rigidity
    • seizures
    • unequal pupil size
    • vomiting

    Resources You Should Know About

    Your Training and Curriculum Specialist or manager can be valuable resources as you learn about the signs of child abuse and neglect. They are your first line of support. Go to them whenever you have questions or concerns.

    Your Family Advocacy Program can provide training and technical support around recognizing child abuse and neglect. Talk to your T&Cs, manager, and Family Advocacy Program representative about any questions or concerns you have.

    The Family Advocacy Program will provide more installation- and Service-specific training on local issues, protocols, and resources. You will also receive additional training from your T&Cs throughout your career. The Virtual Lab School course is just the beginning of your professional learning around reporting and preventing child abuse and neglect.

    Scope and Mission of Family Advocacy Programs

    Your FAP team can help you recognize the signs of child abuse and neglect

    You can find a quick summary of FAP roles and responsibilities as an attachment at the end of the Learn section.

    See

    Signs of Familial and Institutional Abuse

    The following are signs often associated with particular types of child abuse and neglect. It is important to note, however, 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, there are two kinds of abuse to remain aware of: familial and institutional. The signs and behavioral indicators you see in children may be similar for each.

    Physical Abuse

    You might see a child that…
    • An infant who…
      • 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
    • A toddler or 2-year-old who…
      • 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 extremely withdrawn or crying more than is typical
    You might see a parent or adult that…
    • Uses harsh physical punishment
    • Offers conflicting, unconvincing, or no explanation for the injury
    • Describes the child as "evil" or "bad"
    Examples of Familial Physical Abuse…
    • During a diaper change for a 6-month-old baby, her 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 her eyes aren't focusing and she doesn't seem like herself.
    Example of Institutional Physical Abuse…
    • A staff member in the pre-toddler room has had a very hard day. Fiona, 18 months, has been crying and throwing herself on the floor for 10 minutes. It's time to get the kids outside. In frustration, the staff member 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.

    Sexual Abuse

    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
    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
    Examples of Familial Sexual Abuse…
    • A two year old girl sits and plays with dolls. She touches the genitals and says, "It hurts, but it's OK."
    • An 11-month-old boy screams and tries to prevent a bowel movement. His anus is red, swollen, and has dried blood around it.
    Examples of Institutional Sexual Abuse…
    • A staff member offers to take Jerusha inside for a diaper change. Jerusha screams, "No" and hides behind another staff member's legs. "No hurt," she screams.
    • A staff member 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.

    Emotional Abuse

    You might see a child that…
    • Seems indifferent or unattached to the parent
    • Calls themselves "bad"
    • Is very withdrawn or aggressive
    • Excessive crying
    You might see a parent or adult that…
    • Rejects the infant's needs
    • 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
    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!"
    Examples of Institutional Emotional Abuse…
    • A staff member calls a 2-year-old a "stupid baby" when he soils his pants.
    • A staff member belittles a toddler by saying, "Even those babies over there can climb the slide. What's wrong with you?"

    Neglect

    You might see a child that…
    • Lacks needed medical care
    • Lacks clothing appropriate for the weather
    • Is consistently dirty
    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
    Example 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.
    Example of Institutional Neglect…
    • A staff member walks out of the room and leaves her co-worker out of ratio.

    Recognizing Child Abuse and Neglect in Child Development Centers 

    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 to your PUBLICT&Cs or manager.MILT&Cs, manager, or FAP. In the course on Preventing Child Abuse in Center 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 development centers. If you see a pattern of any of these signs or behaviors, you might suspect child abuse or neglect in your setting:

    Signs of Abuse in Programs

    Physical

    • A staff member hits or strikes a child.
    • A staff member uses corporal punishment like spanking or whipping.

    Sexual

    • A staff member touches a child sexually or forces a child to touch the staff member sexually.

    Emotional

    • A staff member publicly ridicules a child for having an accident and soiling his pants.

    Neglect

    • A staff member takes an unscheduled break and leaves the program out of ratio or children unsupervised.
    • A staff member withholds food as “punishment.”
    • Staff members ignore a fight between two children, and a child is seriously injured.
    • A staff member leaves children unsupervised while using dangerous equipment, or the staff member does not stop dangerous behaviors while using the equipment.

    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 or FAP make that determination. This section is intended only to give you some basic information about customs that 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 lit 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.

    Do

    • 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 offered by your installation’s Family Advocacy Program 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 trainer or manager for information if you need help. When in doubt, make a report. Child Protective Services MILor the Family Advocacy Program will decide whether abuse has occurred.
    • Learn reporting procedures for your stateMIL or installation. You will learn more about this in the next lesson.

    Explore

    Explore

    Learn more about the scenario that you read in Lesson 1. This time, look for the signs of abuse and neglect. Then answer the reflection questions. When you are finished, share your answers with your trainer, supervisor, or coach. Then, review the suggested responses for additional reflection on Timothy’s story.

    Apply

    Apply

    Download and print this fact sheet entitled 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.

    Glossary

    TermDescription
    Emotional abuseA pattern of behavior by adults that seriously interferes with a child’s cognitive, emotional, psychological or social development
    Familial abuse and neglectAbuse or neglect committed by a parent, guardian, or member of the family
    Guidance and touch policyThe policy your program has developed that describes the boundaries of acceptable and unacceptable discipline procedures and ways of touching children
    Institutional abuse and neglectAbuse 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.)
    NeglectFailure 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 abuseNon-accidental trauma or injury
    Sexual abuseThe involvement of a child in any sexual touching, depiction, or activity

    Demonstrate

    Demonstrate
    Assessment

    Q1

    Which of the following scenarios might make you suspect child abuse or neglect?

    Q2

    True or false? Parents are the only people who commit child abuse or neglect.

    Q3

    A mobile infant comes in with new bruises. What should you do first?

    Q4

    Which of the following is not an example or sign of institutional abuse or neglect?

    Q5

    Which of the following is not a sign of familial abuse or neglect?

    References & Resources

    Center for the Study of Social Policy (n.d.). Strengthening Families: A Protective Factors Framework. Retrieved from https://cssp.org/our-work/projects/protective-factors-framework/ 

    Centers for Disease Control and Prevention. (2013). Violence Prevention. Retrieved from http://www.cdc.gov/violenceprevention/

    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 http://www.nlm.nih.gov/medlineplus/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.

    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