Child Abuse

 

For 2014, there were a nationally estimated 702,000 victims of abuse and neglect, resulting in a rate of 9.4 victims per 1,000 children in the population. The youngest children are the most vulnerable to maltreatment. In FFY 2014, 52 states reported that more than one-quarter (27.4%) of victims were younger than 3 years.

The percentages (not shown) of child victims were similar for both boys (48.9) and girls (50.7). African-American children had the highest rate of victimization at 15.3 per 1,000 children in the population of the same race or ethnicity and American Indian or Alaska Native children had the second highest rate at 13.4 per 1,000 children. Hispanic and White children had lower rates of victimization at 8.8 and 8.4 per 1,000 children in the population of the same race or ethnicity.

For FFY 2014, a nationally estimated 1,580 children died from abuse and neglect at a rate of 2.13 per 100,000 children in the population. Studies conclude that professionals that have contact with children report only half of the incidents that may be abuse or maltreatment/neglect (Research foundation, 2011). The reason for this low report rate was due to confusion or misunderstanding about the laws and procedures and a lack of knowledge or awareness of warning signs. The study also found that professionals are often influenced by their professional beliefs values and past experiences (Research foundation, 2011). This prompted the state of New York to require mandated reporter training.

Child Abuse and Maltreatment/Neglect

Children are defined as individuals from birth up to 18 years of age; therefore, prenatal harm does not fall into the mandated reporter responsibility. However, if a child is born with a positive toxicology, that can be reported. Individuals no more than 21 years of age that have a handicapping condition and are in residential care in certain New York schools for the blind or deaf or private residential schools for special education services may also be reported to SCR(state central register).

In identifying reasonable cause, for reporting to SCR, consider:

  1. the child’s age
  2. what has happened to the child that leads you to believe there may be harm or risk of harm to the child
  3. how the parent or other persons legally responsible may be culpable for the conditions or circumstance

Maltreatment involves the quality of care the child receives. Abuse reflects the seriousness of the injury. There has to be a connection between harm to the child, or substantial likelihood of harm, and the actions or inactions of the person responsible for the child. Do not worry about classifying the incident as abuse or maltreatment; that is the job for SCR and will be decided during the investigation.

Elements of abuse are defined in the Family Court Act 1012.

A. Subject inflicts or allows to be inflicted on a child serious physical injury by other than accidental means?

AND

B. Such action causes or creates a substantial risk of death or serious or protracted disfigurement, impairment of physical or emotional health or impairment of the function of any bodily organ

OR

C. Subject creates or allows to be created a substantial risk of physical injury to the child by other than accidental means

AND

D Such action causes or creates a substantial risk of death or serious or protracted disfigurement, impairment of physical or emotional health, or impairment of the function of any bodily organ

OR

E. Subject commits or allows to be committed a sex offense as described in section 130 of the penal law

  1. Sexual misconduct
  2. Rape
  3. Criminal sexual act
  4. Forcible touching
  5. Persistent sexual abuse
  6. Sexual abuse
  7. Aggravated sexual abuse
  8. Course of sexual conduct against the child
  9. Female genital mutilation
  10. Facilitating a sex offense with a controlled substance

OR

F. Subject commits or encourages the child to engage in any act defined in section 230.25, 230.30, or 230.32 of the penal law (promoting prostitution)

OR

G. Subject commits any acts described in section 255.25 of the penal law (incest)

OR

H. Subject allows child to engage in acts described in article 263 of the penal law:

  1. Use of a child in a sexual performance
  2. Promoting an obscene sexual performance by a child
  3. Possessing an obscene sexual performance by a child
  4. Promoting a sexual performance by a child
  5. Possessing a sexual performance by child

The terms maltreatment and neglect are often used interchangeably. Maltreatment is defined as:

A. A child whose physical, mental, or emotional condition has been impaired or is at imminent danger of becoming impaired

AND

B. The subject failed to exercise a minimum degree of care

  1. in supplying adequate food, clothing, or shelter, or
  2. in supplying adequate education, or
  3. in supplying medical or dental care though financially able to do so or offered financial or other reasonable means to do so, or
  4. in providing proper supervision or guardianship, or
  5. by inflicting excessive corporal punishment, or
  6. by misuse of drugs or alcohol

AND

C. There is a causal connection between the child’s conditions in the subject’s failure to exercise the minimum degree of care

OR

D. The parent has abandoned the child by demonstrating intent to forgo his or her parental rights and obligations by failing to visit the child to communicate with the child though able to do so.

Even if a child is abandoned under the Abandoned Infant Protection Act, the case must be reported to SCR.

The terms minimum degree of care and excessive corporal punishment are vague and open to interpretation. Decisions are made by CPS based on case-by-case determination. They consider the form of punishment, its ability to cause serious injury, the purpose of the punishment, and what the child did to receive the punishment. The following questions might help focus the mandated reporters thought process:

  • Does the child, based on age, maturity, physical/mental condition, lack the capacity to understand the corrective quality of the discipline?
  • Is a less severe method of punishment available and likely to be effective?
  • Is the punishment unnecessarily degrading to the child?
  • Was the punishment inflicted for gratification of the parents rage?
  • Was the punishment brutal?
  • Did the punishment last for such a time that it surpasses the child’s power of endurance?

Case examples

A mother slaps her 16-year-old daughter for being disrespectful. The child did not sustain any bruises. This type of discipline would not be considered excessive.

A mother slaps her 12-year-old daughter for being disrespectful. As a result of this level of physical discipline, the child sustained an upper lip laceration on the right side of her face. This type of discipline should be reported to SCR.

Indicators

Indicators of abuse warn the mandated reporter to pay more attention to a particular situation. Sometimes there are no indicators even though the child is being abused. There are three types of indicators of abuse or maltreatment/neglect; 1) physical indicators, 2) child behavioral indicators, and 3) parent behavioral indicators.

Indicators should not be viewed in isolation they must be considered in relationship to the child’s condition. Indicators should be considered in the overall context of the child’s physical appearance and behavior. Sometimes a single indicator is self-evident or points to abuse or maltreatment/neglect. Often several indicators must be pulled together or clusters of indicators used to develop reasonable cause.

Some mandated reporters see a child only once are very infrequently others see them more often. In looking for reasonable cause you need to consider what you know about the child’s normal behavior. No two children will respond the same way to the same situation.

Physical Indicators

Common physical indicators are severe unexplained or suspicious bruises and welts, fractures, burns, lacerations, or abrasions. Specific physical indicators are:

  • unexplained bruises and welts
    • On face, lips, mouth, torso, back, buttocks or thighs.
      Handprint Injury
    • Bruises of torso, buttock, and thighs
    • Bruises in various stages of healing clustered bruises forming regular patterns that might reflect the shape of an article used to inflict the injury
    • Bruises on several different areas
    • Bruises regularly appear after absence, weekend, or vacation
  • unexplained fractures
    • to nose, skull, or facial structure
    • In various stages of healing
    • Multiple or Spiral fractures
    • swollen or tender lambs
  • Unexplained burns
    • Cigar, cigarette burns especially on the soles of feet, palms, back and buttocks
    • Immersion burns: sock like, glove like, doughnut shaped on buttocks or genitalia
    • Patterned like electric burner or iron
    • Rope burns on arms, legs, neck, or torso
  • Unexplained lacerations or abrasions
    • To mouth, lips, gums, or eyes
    • To external genitalia
    • On back of arms, legs, or torso
    • Human bite marks
    • Frequent injuries that are accidental or unexplained

Accidental injuries usually involve injury on a bony prominence of the body such as elbows and knees and shins. Suspicious injuries usually occur in areas not susceptible to accidental age- appropriate areas. The following pictures indicate areas where children would normally bruises, and suspicious bruising areas, as well as other suspicious areas of injury.

Bruising Areas(AbuseWatch.net, 2012)

Clues to the mechanism of injury:

Clues to the mechanism of injury

Consider the size and shape of the injury, as well as the location of injury (Research foundation, 2011). Consider the relationship of the mechanism of injury (explanation of how injury occurred) to the child’s developmental stage. For example toddlers fall when they learn to walk and young children scrape their knees when learning to ride a bicycle. Consider if the story that was given as an explanation for an injury would produce the physical indicators that are present. For instance a toddler falls to the floor while walking, not striking anything when he fell. That toddler has bruises on the back of his legs. One would expect that from a fall, while walking, the toddler would have bruises and scrapes on his hands, knees, and shins; not bruises on the back of his legs.

Child behavioral indicators of physical abuse may be:

  1. the child is wary of adult contact,
  2. apprehensive when other children cry,
  3. demonstrates behavioral extremes,
  4. frightened of parents,
  5. afraid to go home,
  6. reports injury by parent,
  7. wears long sleeve or similar clothing to hide injuries,
  8. Seeks affection from adults.

Parent behavioral indicators of physical abuse may be :

  1. seemed unconcerned about the child
  2. takes an usual amount of time to obtain medical care for the child
  3. offers inadequate or inappropriate explanations for the injury
  4. gives different explanations for the same injury
  5. misuses drugs or alcohol
  6. disciplines the child to harshly considering the child’s age or what she has done wrong
  7. sees the child as bad or evil
  8. has a history of abuse as a child
  9. attempts to conceal the child’s injury
  10. takes a child to a different hospital or doctor for each injury
  11. has poor impulse control

Maltreatment/Neglect

Child physical indicators of maltreatment/neglect may be:

  1. consistent hunger, poor hygiene, inappropriate dress
  2. consistent lack of supervision, especially in dangerous activities or for long periods
  3. unattended physical problems or medical or dental needs
  4. abandonment

Child behavioral indicators of maltreatment/neglect may be:

  1. begging or stealing food
  2. extended stays in school – arrives early, leaves late
  3. attendance at school infrequent
  4. consistent fatigue, falls asleep in class
  5. alcohol and drug abuse
  6. states there is no caretaker

Parental behavior indicators of maltreatment/neglect may be:

  1. misuses alcohol or other drugs
  2. has disorganized, upsetting home life
  3. is apathetic, feeling nothing will change
  4. is isolated from friends, relatives, neighbors
  5. has long term chronic illness
  6. cannot be found
  7. has history of neglect as a child
  8. exposes child to unsafe living conditions
  9. evidences limited intellectual capacity

Emotional Maltreatment

Child physical indicators of emotional maltreatment may be:

  1. Conduct disorders such as fighting in school, antisocial, or destructive.
  2. Habit disorders such as rocking, fighting, or sucking fingers
  3. neurotic disorders such as speech disorders, sleep problems, or inhibition of play
  4. psychoneurotic reactions such as phobias, hysterical reactions, compulsions, or hypochondria
  5. lags in physical development
  6. failure to thrive
    Photograph of patient with marked failure to thrive.

Child behavioral indicators of emotional maltreatment may be :

  1. overly adaptive behavior such as inappropriately adult or inappropriately infantile
  2. developmental delays, mental or emotional
  3. extremes of behavior such as compliant, passive, aggressive, or demanding
  4. suicide attempt or gestures or self-mutilation

Parent behavioral indicators of emotional maltreatment may be :

  1. treats children in the family unequally
  2. doesn’t seem to care much about child’s problem
  3. blames or belittles child
  4. is cold and rejecting
  5. inconsistent behavior toward child

Sexual Abuse

Child physical indicators of sexual abuse may be:

  1. difficulty in walking or sitting
  2. Torn, sustained, or bloody underclothing,
  3. Pain or itching in genitalia.
  4. bruises or bleeding in external genitalia, vaginal or anal areas
  5. sexually transmitted diseases especially in pre-adolescent age group, includes venereal oral infections

Child behavioral indicators of sexual abuse may be:

  1. unwilling to change for or participate in physical education class
  2. withdrawal, fantasy, or infantile behavior
  3. bizarre, sophisticated, unusual sexual behavior or knowledge
  4. self-injurious behaviors, suicide attempts
  5. poor peer relationships
  6. aggressive or disruptive behavior, delinquency, running away, or school truancy
  7. reports sexual assault by caretakers
  8. exaggerated fear of closeness or physical contact

Parent behavioral indicators of sexual abuse may be:

  1. very protective or jealous of child
  2. encourages child to engage in prostitution or sexual acts in the presence of caretaker
  3. misuses alcohol or drugs
  4. is geographically isolated and/or lacking in social and emotional contacts outside the family
  5. has low self-esteem

Talking with Children

The role of the mandated reporter is to assess for reasonable cause to suspect maltreatment/neglect or abuse. The mandated reporter is not to investigate or interrogate. The mandated reporter identifies reasonable cause and leaves the investigation and interrogation to specially trained workers in SCR and CPS (child protective service).

When talking with children to establish reasonable cause, find a private place and remain calm. Be honest, open, and up front with the child. Be supportive. Listen to the child and stress that it’s not the child’s fault. Do not overreact, make judgments, make promises, nor interrogate or investigate.

There is no legal requirement to inform the parent or other persons legally responsible for the child’s care that you are making a report to SCR. In fact, informing the parents of the report may place the child for the risk of harm. Do not assume that the parent will support the child. If you have questions about whether to inform the parents, contact your local CPS.

In the case of suspected sexual abuse, avoid talking in detail with the child about the incident. There are special guidelines that apply to the case of suspected sexual abuse. Usually, CPS and law enforcement work together to interview the child same time using specially trained professionals.

What Is Reasonable Cause to Suspect Abuse or Maltreatment

Reasonable cause to suspect things that based on what you have observed or been told, combined with your training and experience, you feel harm or imminent danger of harm to the child could be the result of an act or omission by the person legally responsible for the child. If there is reasonable cause to suspect the child is being abused or maltreated you must call SCR immediately (Research foundation, 2011, Trainer’s Presentation Guide, pg. 26).

Crimes committed against the child should be reported directly to law enforcement. If you’re uncertain if the incidence is criminal, you can contact the SCR anyway. If the child is in imminent danger, contact law enforcement immediately. Imminent danger is when the child is placed at immediate risk or a substantial risk of harm. In other words, how direct is the threat to the child? The danger must be immediate or nearly immediate (Research foundation, 2011).

Case Studies

  • A female, age 15, has comes to the ER with the rash on her vaginal area. She discloses she has been engaging in sexual intercourse with her mother’s 38-year-old boyfriend for the past two months. The boyfriend has resided in the house with the child and her mother for the past five years and is responsible for the care of the child when the mother is at work (Research foundation, 2011, Participant Guide, Medical pg. 15).
    • What indicators are present?
    • Is there a reasonable cost to suspect abuse or maltreatment?
    • Is there a parent or other person responsible for the suspected abuse or maltreatment?
    • What are your next steps?
  • Seven-year-old Chris came to the doctor’s office for a physical. He has a bruise on the right side of his face with scrapes along his right arm. The child claimed he fell off his bike. The child lives with his mother, a single parent. She says Chris is a very active child and at times can present challenging behaviors at school (Research foundation, 2011, Participant Guide, Medical pg. 16).
    • What indicators are present?
    • Is there reasonable cause to suspect abuse or maltreatment?
    • Is there a parent or other person responsible for the suspected abuse or maltreatment?
    • What are your next steps?
  • A mother delivers a baby that has neonatal drug withdrawal. When talking to the mother, you learned she has not prepared for baby to come home (Research foundation, 2011, Participant Guide, Medical pg. 17).
    • What indicators are present?
    • Is there reasonable cause to suspect abuse or maltreatment?
    • Is there a parent or other person responsible for the suspected abuse or maltreatment?
    • What are your next steps?
  • Eight-year-old Jason comes to the ER with a broken arm. His mother says he fell off the bed. When Jason Jason’s arm is x-rayed there’s a spiral fracture to his humorous (Research foundation, 2011, Participant Guide, Medical pg. 18).
    • What indicators are present?
    • Is there reasonable cause to suspect abuse or maltreatment?
    • Is there a parent or other person responsible for the suspected abuse or maltreatment?
    • What are your next steps?

Case Study Answers

Case Study A

  • What indicators are present? Sexual abuse and verbal disclosure
  • Is there reasonable cause to suspect abuse or maltreatment? Yes
  • Is there a parent or other person responsible for the suspected abuse or maltreatment? 38-year-old boyfriend is an adult living in the home acting as a caregiver
  • What are your next steps? Call SCR

Case Study B

  • What indicators are present? Bruises, scrapes
  • Is there reasonable cause to suspect abuse or maltreatment? No, the story is consistent with a bike injury. Injuries sustained in an accidental fall would be along one side of the child’s body.
  • Is there a parent or other person responsible for the suspected abuse or maltreatment? No
  • What are your next steps? Treat child’s injury.

Case Study C

  • What indicators are present? Neonatal drug withdrawal and no plan for the baby
  • Is there reasonable cause to suspect abuse or maltreatment? Yes
  • Is there a parent or other person responsible for the suspected abuse or maltreatment? Mother
  • What are your next steps? Call SCR

Case Study D

  • What indicators are present? Spiral fracture, explanation is not plausible
  • Is there reasonable cause to suspect abuse or maltreatment? Yes
  • Is there a parent or other person responsible for the suspected abuse or maltreatment? Mother
  • What are your next steps? Call SCR

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