This lesson may have content specific to certain audiences. Differences between audience views may be subtle or non-existent. Please select your audience:

Secondary tabs

    Objectives
    • Identify examples of behaviors that might indicate familial and institutional abuse.
    • Observe children for signs of abuse and neglect.
    • Teach staff to identify the signs and behavioral indicators of child abuse and neglect.

    Learn

    Learn

    Teach

    The staff members you work with do their best every day to keep children safe. Suspecting child abuse or neglect can be the most difficult professional experience they encounter. It is an experience that can challenge them personally and professionally. Your role is to help staff learn the signs and behavioral indicators of child abuse and neglect. You can help them process information and support them as they make the decision to report their suspicions.

    To do this important work, 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
    • 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    • Is overly compliant, passive, or withdrawn
    • Comes to the program or other activities early, stays late, or does not want to go home

    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)
    • State they do not like each other

    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. Often a pattern or combination of behaviors will lead to the suspicion that a child is experiencing abuse or neglect. Watch this video to learn about the long-term effects of abuse and neglect for children and youth.

    Long Term Effects of Child Abuse and Neglect

    Learn about the long-term effects of abuse and neglect

    A Reasonable Suspicion of Child Abuse or Neglect

    It is not uncommon for staff members to doubt themselves when they suspect child abuse or neglect. In many ways, this is human nature: we want to see the best in families and co-workers. Unfortunately, doubting oneself about suspicions of child abuse or neglect can be very dangerous. You must help staff members learn to recognize the signs that constitute a reasonable suspicion. You can also help them learn to follow their instincts. You can begin doing this by simply helping them understand the term suspicion . A suspicion is an unsubstantiated belief that something is wrong. It is an inkling or a feeling, based on observation or experience, that a child is being mistreated. Staff members do not need to prove that child abuse or neglect is occurring. They do not need to investigate. They do not even need to know who the suspected abuser is. If they think a child has been harmed or is in danger of being harmed, they have a reasonable suspicion of child abuse or neglect.

    Collaborating with FAP

    Your Family Advocacy Program can provide training and technical support around recognizing child abuse and neglect. The best trainings are often developed in collaboration between you and the FAP staff. Reach out to the FAP office on your installation. Learn about the resources they can provide. They are only a phone call away, and they can help you and staff members talk through what you have observed. They can help recognize whether or not a reasonable suspicion of child abuse or neglect has occurred.

    Getting Help: Family Advocacy Programs

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

    Model

    Ask Questions and Open the Lines of Communication

    All children 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. 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 or a staff member notice an injury or symptom in a child, ask the family member about it. This is a standard part of caregiving and shows that your program takes an interest in the child’s well-being. 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. 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, and school-age children, you should 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.

    Understand and Discuss Age-Specific Risks:

    Internet Predators and Cyber-Bullying

    School-age children are growing up in a world of online social networks. They may have access to websites where they have “friends” they have never actually met. Staff members 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 Safety lesson. Make sure that you and all staff members can 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 and program staff:

    • Can always see the monitors when children are on computers
    • Check browser histories
    • Install software that blocks questionable content
    • Talk to school-age children about safe internet use

    Remember that many school-age children have access to the internet at all times on smartphones or handheld devices. Help staff members talk to school-age children about safe phone use and texting. Discuss boundaries related to sharing images and content. Make sure children feel safe talking to an adult if (a) they receive inappropriate content from another child or an adult or (b) they are being asked to share inappropriate content or images of themselves. Also be aware of staff members’ phone use in the program: make sure staff members know appropriate boundaries for communication with children.

    All staff 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 stories in the media 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 or school-age program staff. As a Training & Curriculum Specialist, you must remain alert for these situations and handle them appropriately. Enforce your program’s Guidance and Touch Policy with all staff members. Teach staff members how to respond if an older child does something that makes them uncomfortable: sits on a staff members lap, squeezes in next to an adult on the couch, or grabs a staff members hand. Make sure staff members know to avoid being alone with a child. Make sure staff members know that they should never share images, videos, jokes, or content that are sexual or romantic in nature.

    Remember that you and program staff are working with young children and pre-teens. 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 a staff member, another adult, teen, or another child, you must make a report. You will learn about reporting procedures in the next lesson.

    Examples of Staff or Volunteer Behavior
    in Youth-Serving Organizations

     
    Appropriate
    Inappropriate or Harmful

    Verbal

    • Praise
    • Positive reinforcement for good work or behavior
    • Sexually provocative or degrading comments
    • Risqué jokes

    Physical

    • Patting a child on the back
    • Holding the hand of a young school-age child as they get off the bus
    • Brief hugging as long as the child appears comfortable and the contact is not romanticized or sexually intimate
    • Patting the buttocks
    • Intimate, romantic, or sexual contact
    • Corporal punishment
    • Showing or involving a child in pornographic activities

    Support Program Practices that Promote Recognition of Abuse and Neglect

    • Get to know all of the children in your program and their families. In large programs, this can be challenging. It is critical that you make an effort, though. Take the time to greet families as they arrive in the mornings and afternoons at different programs. This will go a long way towards helping you learn families’ names and stories. Have conversations with families during special events, and be present in the family resource area of your program. Offer family education events, too. These are great ways to get to know small groups of families. You will be a much more effective resource for staff members if you know the children and families yourself. Talk to families every day. Learn children’s names.
    • Be a resource on child development. Some changes in a child’s behavior can be startling for staff members—but are 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.” Pre-teens might be moody or occasionally say they hate their parents. Knowing these developmental stages can help you know recognize when a child’s behavior goes beyond what is typically expected.
    • Offer trainings in collaboration with your installation’s Family Advocacy Program on child abuse identification and reporting.
    • Develop respectful communication skills. You will learn more about this in the Communication course. You will need these skills to communicate with staff members and families. If a staff member has a concern about a child, listen and help the staff member feel heard. You might say, “It sounds like you are concerned about Samantha. Tell me what you’ve noticed.” If you have a concern about a child, 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. Staff members might have questions, and you can help them find answers. When in doubt, though, encourage staff members to make a report. Child Protective ServicesMIL or the Family Advocacy Program will decide whether abuse has occurred.
    • Communicate the reporting procedures for your state MIL or installation to all staff members. You will learn more about this in the next lesson.

    Observe

    There 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, 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. Read the following scenarios. Then read what a Training and Curriculum Specialist might say or do to help a staff member recognize a reasonable suspicion of child abuse or neglect.

    Remember, though, that it is not your job to investigate or interview a child or family. You and the staff members are mandated to report a suspicion of abuse or neglect. These suspicions are based on your observations and information freely provided by children, families, or staff. Interviewing the victim can actually damage the investigation. The “You Say” column is just meant as a helpful resource for those times when you must make a split-second decision about how to respond. In many cases, it is best just to report what you observed rather than to pry for more information. It is possible to bias a child’s testimony or to make a family defensive before an investigation begins. Always proceed with caution and remember that your role is to report rather than to investigate.

    Observe for Signs of Abuse or Neglect in the Family

    The following tables provide information about what you might see or hear in your programs. It also provides some guidance about what to say and do in these situations. The tables are interactive, so you can click through them to read all of the information. If you prefer, you can download identical information as a PDF at the end of the Learn section.

    Observe for Signs of Abuse or Neglect in the Family

     

    Infants & Toddlers: Physical Abuse: Bruises

    Scenario

    You See a Suspicion of Physical Abuse:

    A 6-month-old baby has been out of the program for a week. Her parents said they had family in town and decided not to bring her in. During a diaper change on her first day back, the infant caregiver notices purple, brown, and yellow bruises on the baby’s inner thighs and buttocks. She calls you to come to the room and look at the bruises. She asks if you could be in the room when the father picks up. When the caregiver asks the baby’s father about the bruises, he says she fell from the crib with the rails up. The caregiver looks at you. You both know the baby does not yet pull up or climb, so this explanation seems unlikely. The father seems very defensive and rushes out of the room with the infant before you can talk.

    You Say

    Say to the Caregiver:

    • “It sounds like you’re concerned about the baby. Let’s write down everything you’ve noticed.”
    • “I heard you say you’re not sure what’s going on. I wonder if you suspect something is wrong…”
    • “Remember, we don’t have to investigate maltreatment or have a definitive answer. Do you think she was harmed? Do you think she is unsafe? If you answer yes, we need to make a call.”

    You Do

    Take Action:

    • Stay with the caregiver if she needs your support while making a report to FAP/CPS. She does not need to investigate any further. She can simply call FAP and report what she saw and heard.

    Infants & Toddlers: Physical Abuse: Head Trauma

    Scenario

    You See a Suspicion of Physical Abuse:

    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. Her mother seems upset. You can hear the caregiver and mother talking as you walk down the hallway. You hear the mother say, "She fell off the couch. She's fine." You enter the room and ask if you can help.

    You Say

    Say to the Mother:

    • "I'm worried that Claire might have gotten hurt. We don't want to take any chances with head injuries. I think we should call 911."

    You Do

    Take Action:

    • Call 911 or EMS. Regardless of whether this is an example of abuse, neglect, or maltreatment, the baby might have experienced head trauma.
    • Help the caregiver complete an incident report or other documentation about her observations.

    Preschool: Physical Abuse: Bite Marks

    Scenario

    You See a Suspicion of Physical Abuse:

    A preschool teacher escorts a child to the front desk, so the management team can look at an injury. He appears to have a set of human bite marks on his arm. When you ask what happens, he says, "I bit my brother, so mom bit me back."

    You Say

    Call FAP/CPS right away.

    • This is a situation where it might be best not to ask any additional questions. Rather, call FAP/CPS right away so they can begin an investigation.

    You Do

    Take Action:

    • Call FAP/ CPS.
    • Document the child's injury in health screening forms and follow your program's procedures for notifying families.

    School-Age: Physical Abuse: Burn Marks

    Scenario

    You See a Suspicion of Physical Abuse:

    It's the first warm day of spring, and Jordyn, age 10, is wearing shorts. You notice she has circular burn marks up and down her thighs. They are the size and shape of a cigarette. You ask her what happened to her legs, and she says, "Nothing."

    You Say

    Say to the Child:

    • "Jordyn, that looks like it really hurt. I want to help you. You can tell me what happened."

    You Do

    Take Action:

    • Call FAP/CPS.
    • Document the child's injury in health screening forms and follow your program's procedures for notifying families.

    Infants & Toddlers: Sexual Abuse: A

    Scenario

    You See a Suspicion of Sexual Abuse:

    A two year old girl sits and plays with dolls. She touches the genitals and says, "It hurts, but it's OK."

    You Say

    Say to the Classroom Staff:

    • "Have you noticed anything like this before? Has anything changed recently in her life? New people? New house?"

    You Do

    Take Action:

    • Document the observation.
    • Call FAP/CPS and describe what was observed. Ask for guidance.

    Infants & Toddlers: Sexual Abuse: B

    Scenario

    You See a Suspicion of Sexual Abuse:

    The infant staff calls you for support. An 11-month-old boy is screaming and trying to prevent a bowel movement. His anus is red, swollen, and has dried blood around it.

    You Say

    Say to the Classroom Staff:

    • "When did the pain start? When was his last bowel movement?"

    You Do

    Take Action:

    • Document the observation.
    • Call FAP/CPS and describe what was observed. Ask for guidance.
    • Call the family because the child should be examined by a doctor right away.

    Preschool: Sexual Abuse: A

    Scenario

    You See a Suspicion of Sexual Abuse:

    Preschool staff members see Candice, age 4, 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. The staff come to you because they are not sure what to do.

    You Say

    Say to the Classroom Staff:

    • "Have you noticed Candice doing this before? Have you noticed any other sexual behaviors?"

    You Do

    Take Action:

    • Document the observation.
    • Call FAP/CPS and describe what was observed. Ask for guidance.

    School-Age: Sexual Abuse: A

    Scenario

    You See a Suspicion of Sexual Abuse:

    Amelia's 19-year-old brother is coming to pick her up today from the school-age program. She tells you she loves her brother and they have "secrets" in her room at night.

    You Say

    Say:

    To the child:

    • "Amelia, there are some kinds of secrets that it is OK to tell grown-ups and teachers about. We're going to call some people who it's ok to talk to."

    To staff members:

    • "Has Amelia said anything else today about her brother or secrets? Do you know her brother?"

    You Do

    Take Action:

    • Document the observation.
    • Call FAP/CPS and describe what was observed.

    Infants & Toddlers: Emotional Abuse: A

    Scenario

    You See a Suspicion of Emotional Abuse:

    A mother walks through the front door of your program while you are standing at the front desk. She grabs her toddler by the arm and says, "Be good today, or I won't pick you up this afternoon."

    You Say

    Say to the Mother:

    • "Is everything ok? We're glad you're here, and Toby will definitely have a great day."
    • Ask the mom if she has a few minutes to chat on her way out or in the afternoon. "I wonder if it makes Toby scared to think you won't pick him up…"

    You Do

    Take Action:

    • Schedule a time to talk to the mother.
    • Document the observation and look for patterns.

    Preschool: Emotional Abuse: A

    Scenario

    You See a Suspicion of Emotional Abuse:

    A staff member comes to you upset. She says she doesn't know what to do about Dora's father. Every day when he comes to pick Dora up from the program he says mean things to her. Today he told her to stop being "slow and stupid like her mom." Yesterday he said how much easier life would be if he didn't have to worry about her.

    You Say

    Say to the Staff Member:

    • "It sounds like you're really concerned for Dora. Tell me more about what you've observed…"

    You Do

    Take Action:

    • Organize or help connect the family with education events on positive parenting.
    • Talk toMIL FAP PUBLIC your program's mental health professional about what has been observed and resources or supports for Dora's father and family.

    Preschool: Emotional Abuse: A

    Scenario

    You See a Suspicion of Emotional Abuse:

    A staff member comes to you upset. She says she doesn't know what to do about Dora's father. Every day when he comes to pick Dora up from the program he says mean things to her. Today he told her to stop being "slow and stupid like her mom." Yesterday he said how much easier life would be if he didn't have to worry about her.

    You Say

    Say to the Staff Member:

    • "It sounds like you're really concerned for Dora. Tell me more about what you've observed…"

    You Do

    Take Action:

    • Organize or help connect the family with education events on positive parenting.
    • Talk toMILFAPPUBLIC your program's mental health professional about what has been observed and resources or supports for Dora's father and family.

    Infants & Toddlers: Neglect: A

    Scenario

    You See a Suspicion of 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.

    You Say

    Say to the Father:

    • "Mr. Thomas, we're really worried about Madeleine's rash. It looks like it is painful. We will make sure we check her diaper every hour and make sure she gets completely dry each change. There are also some ointments that could be helpful. Have you tried anything that works at home? What else can we do to help?"

    You Do

    Take Action:

    • Make sure the family knows about community resources if they are having a hard time affording diapers or ointment.
    • Provide information about or model healthy diapering procedures.
    • Continue monitoring the situation.
    • If the situation does not improve or there are other signs of maltreatment, call FAP/CPS.

    Preschool: Neglect: A

    Scenario

    You See a Suspicion of Neglect:

    6-year-old Marjorie tells you she had to make dinner for her two younger siblings (ages 1 and 2) when her mom went to work. No other adults were in the home.

    You Say

    Say to the Child:

    • "Wow, I bet that was hard."
    • With a child of this age, it might be best not to elaborate on the story. Make the report and let FAP/CPS investigate.

    You Do

    Take Action:

    • Call FAP/CPS and report what you heard.
    • Find out if the family needs help finding babysitters or building social connections.

    School-Age: Neglect: A

    Scenario

    You See a Suspicion of Neglect:

    Zach's mom has not brought in a replacement for his empty rescue inhaler. Zach has severe asthma and needs the medication.

    You Say

    Say to the Child:

    • "Mrs. Jones, Zach's emergency inhaler is empty. We can't keep him here safely without the inhaler."

    You Do

    Take Action:

    • Make sure Zach's mom has access to needed medical services.
    • If the problem persists, call FAP/CPS.

    Observe Children for Signs of Abuse in the Program

    Observe Children for Signs of Abuse in the Program

     

    Physical Abuse: Bruises

    Scenario

    You See a Suspicion of 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.

    You Say

    Say to the Staff Member:

    • "I think you need to go take a break in the office right now. I'll cover the classroom and be up to talk in a few minutes."

    You Do

    Take Action:

    • Call FAP/CPS.
    • Talk to management and make sure the staff member is removed from settings with children while the incident is investigated.
    • Support staffing in the classroom to ensure adequate supervision.
    • Support management to follow procedures for incident reporting and notifying the family.

    Remember that every employee of the child development programs 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 their 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 equally important for you and the direct care staff members. Take time to make sure you know what to look for and how to help staff members spot the signs.

    Explore

    Explore

    Learn more about the scenario that you read in Lesson 1. Download and print the Case Study activity. This time, look for the signs of abuse and neglect. Then answer the reflection questions. Review the suggested responses for additional reflection on Bethany and Braden’s story.

    Apply

    Apply

    Download and print the 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.

    You can also find scenario cards to use with staff members. Download and print the Scenario Cards. During staff trainings or other professional development events, share a scenario with staff members. Talk about whether the scenario would make them suspect abuse or neglect. Then role play what they would do or say if they experienced each scenario.

    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

    As you are greeting families at the front desk, a child comes in with new bruises on his face. What should you do first?

    Q4

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

    Q5

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

    References & Resources

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

    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.

    Harper Browne, C. (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/wp-content/uploads/2018/11/Branching-Out-and-Reaching-Deeper.pdf

    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