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TYPES OF ABUSE �

CHLD 134�LAURA DENISE HARRIS, ED.D.�

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OBJECTIVES�UPON COMPLETION OF THIS LEARNING SECTION, STUDENTS WILL BE ABLE TO...

List, identify, define, compare, & contrast the four different types of child abuse.

01

Discuss indicators of each kind of abuse.

02

Convey understanding of what circumstances are not classified as child abuse.

03

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Physical Abuse

Neglect

Emotional Abuse

Sexual Abuse

Four Types of Child Abuse

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PHYSICAL ABUSE

Any non accidental act that results in physical injury to a child.

Usually, the result of severe corporal punishment or unjustifiable punishment.

Most frequently happens in the following situations:

Person is frustrated or angry and strikes, shakes or throws the child.
Intentional, deliberate assault including burning, biting, cutting, poking, twisting limbs, or torturing a child in some other way.

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INDICATORS

Location/Type of Injury

History

Behavioral Indicators

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LOCATION/TYPE OF INJURY

Padded areas raise greater concern: buttocks, back of legs, genitalia and cheeks

It takes more force to cause bruising on these areas.

Patterned injuries (loop marks, slap marks, finger marks) are highly suspicious and may indicate trauma.

Bruises are caused when the blood vessels under the skin are broken.

Commonly found: Forehead, knees, shins. Caused by children old enough to walk who are making contact with the floor or other surfaces to normal areas of the body.
Uncommon: Ears, neck, upper lip. Difficult to accidentally bump or fall on these areas.
Spanking with an open palm should not be forceful enough to bruise the buttocks.

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Slap marks.
Metal chain
Hand slap (fingerprints)

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HISTORY

Include all the facts about the child and the injury, along with the following information:

Statements by the child that injury was caused by abuse.
Knowledge that a child’s injury is unusual for a specific age group (any fracture in an infant)
Unexplained injuries

Including nobody able to explain how injury happened, discrepancies in explanation, blame placed on third party, explanations inconsistent with medical diagnosis

Parent delayed seeking care for a child

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BEHAVIORAL INDICATORS

Any time the child has a drastic and sudden behavior change, concern may be raised, especially accompanied by other factors discussed previously.
Keep in mind: behavior changes can also occur due to normal childhood stress (divorce, moving, death in the family, new school, etc.)
Drastic behavior changes, including:

Aggression, violent or destructive behaviors, cruelty to animals, visibly depressed or suicidal, etc.

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TYPES OF PHYSICAL ABUSE

Bruises/Contusions

Not possible to date them. Red, blue, purple, black can occur at any time and bruises look different on the skin of each person.

Abrasions/Lacerations

Location and amount of wounds should be considered.
Lacerations under tongue or on frenulum could be falling with something in the mouth or excessive force during feeding.

Bite Marks
Burns

Location and characteristics determine if abuse or not

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BURNS

Highly suspicious if no evidence of withdrawal

Child will automatically try to escape which should cause splashes, uneven burns, or burns on the hands

Location and characteristics may help determine if abuse or not
Scalding with hot liquid is the most common abuse burn

Young infants usually immersed in water
Older children have liquids thrown or poured on them

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SUSPICIOUS BURNS

Forcibly held in water

Buttocks and genitalia only
Center of buttocks spared (if forced against tub); donut shaped burns

Glove/sock burns

Hands or feet only are put into the water

Pointed/deeper burns

Deeper in the middle usually means a hot liquid was poured or object pressed into the skin

Object branding
Cigarette burns

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Burn from a grate or floor heater. Does this automatically indicate abuse?
Cigarette burns not necessarily indicator. One burn could mean accidentally bumped. Would likely be very light.

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BRAIN DAMAGE

Head injuries

Most common cause of child abuse related deaths
Frequent cause of chronic neurological disabilities
Eyes and nervous system need to be examined by physician, x-rays and toxicology need to be completed
When child is unconscious or unresponsive and no outward signs of injury, physical abuse should be considered

Abusive head trauma (Shaken Baby Syndrome)

20% of cases are fatal within the first few days after injury
Survivors can suffer from a wide range of problems including disabilities
Postmortem examination/autopsy is required in the death of all infants in California

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SHAKEN BABY SYNDROME

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THE DANGERS

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DAMAGE TO INTERNAL ORGANS

Internal Injuries

Vital organs can be injured, and shock or death can result
Second leading cause of death for victims of child abuse
Physical indicators may not be obvious but include abdominal pain, blood in urine, vomiting, etc.

Fractures

Unexplained fracture in infant or toddler
Rib fractures are most common fractures found in abused children and caused from being hit or squeezed; multiple rib fractures cause concern
Unexplainable healing fractures raise concern

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REFLECT & DISCUSS

TALK TO A PARTNER. THOUGHTS, CONCERNS, FEEDBACK, ETC. REGARDING PHYSICAL ABUSE?

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NEGLECT

Neglect

Negligent treatment or maltreatment of a child by a parent or caretaker under circumstances indicating harm or threatened harm to the child’s health or welfare.

Severe Neglect

Negligent failure to protect the child from severe malnutrition or medically diagnosed non-organic failure to thrive.

General Neglect

Negligent failure of a parent or caretaker to provide adequate food, clothing, shelter, medical care, or supervision where no physical injury to the child has occurred.

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GENERAL NEGLECT

Children unsupervised during hours when they are out of school.

Age of the child may leave them vulnerable to accidents, injuries or crime.

Prenatal neglect: substance abuse with significant risk factors indicate parent’s inability to provide child with adequate care.

Controversial:

What age is appropriate for children to be left home alone?
Societal and community responsibilities to provide resources often taken into consideration.
Parents often don’t see any wrongdoing; are working or trying to get other things done for the family.

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SEVERE NEGLECT

Willfully causing or permitting the person or health of the child to be placed in a situation that his or her person or health is endangered.

Intentional failure to provide adequate food, clothing, shelter or medical care.

Failure to protect child from malnutrition or medically diagnosed non-organic failure to thrive.

Non-organic meaning it is not caused by something internally (disability, eating problem, etc.)

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INDICATORS OF NEGLECT

Lacking adequate medical or dental care	Often sleepy or hungry	Often dirty; poor hygiene or inadequately dressed for weather conditions
Depressed, withdrawn, apathetic	Exaggerated fearfulness	Destructive or antisocial behavior
Speech, eating, habit disorders	Evidence of poor supervision (frequent falls, left alone in the home, unsupervised under any circumstances)	Unsanitary conditions in the home
Nutritional quality of food in the home is poor	Sleeping arrangements cold, dirty or inadequate	Child caring for another child

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EMOTIONAL ABUSE

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EMOTIONAL MALTREATMENT

Absence of positive interaction (praising)

Chronically withdrawn & anxious children

Verbal assault (belittling, screaming, threats, blaming, sarcasm)

Unpredictable responses, continual negative moods, family discord, conflicting messages

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INDICATORS - CHILDREN

Withdrawn, depressed, apathetic	Clingy; indiscriminate attachments	Acts out & considered a behavior problem
Exaggerated fearfulness	Overly rigid in conforming to instructions	Sleep, speech or eating disorders
Signs of emotional turmoil (rocking, whining, picking at scabs)	Bed wetting and fecal soiling	Excessive attention to details
Makes comments about people telling them they’re bad	Little or no verbal/physical communication with others

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INDICATORS - PARENTS

Unreasonable demands

Child is battle ground for marital conflicts

Child is objectified (“it”)

Witness to domestic violence

Self fulfilling prophesy – child lives up to image created by parent

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EMOTIONAL DEPRIVATION

Parents do not provide normal experiences of being loved, wanted, secure and worthy.

Depression, substance abuse, parenting deficits, lack of social/financial support

Possible domestic violence situations

Withholding of touch, smiles and sound (interactions) with the child

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INDICATORS

Apathy, withdrawal, lack of response to human interaction

Seeks out and pesters individuals for attention and affection

Refuses to eat adequate amounts of food

Unable to perform normal learned functions for given age

Exaggerated fears

Antisocial behavior displays

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THINK & DISCUSS

The law says reporting situations of emotional deprivation is not mandatory unless it constitutes a form of legally defined abuse or neglect. Often seen as a �lesser form of abuse/neglect. �May not be reportable, or may �be assessed out with no �intervention.
Thoughts?

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SEXUAL ABUSE

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DEFINITION

Includes many acts over a long period of time (chronic molestation) or a single incident.
May begin with non-intimate types of sexual activity to body contact and/or penetration.
Victims from infancy through adolescence.
Sexual assault includes: Rape, incest, sodomy, oral copulation, penetration by a foreign object and child molestation.
Lewd or lascivious conduct:

With a child under 14 years old
With a child 14/15 years of age by somebody 10 years older than the child
Unlawful intercourse with a minor under 16 years of age by someone over 21 years of age

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SEXUAL EXPLOITATION

Conduct or activities related to pornography depicting minors, and promoting prostitution by minors.

Includes:

Any obscene matter which depicts or describes in an offensive way sexual conduct and lacks literary, artistic, political or scientific value.
Importing for sale or distribution.
Possessing, preparing, publishing, producing, printing with intent to exhibit to others.
Offering to distribute or exhibit to others.
Knowingly exhibiting to others.
Exhibiting or exchanging to others for commercial consideration.

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HISTORY

There are some things that should be taken into consideration when gathering data or reflecting on previous occurrences with the child; though alone they do not necessarily constitute the presence of sexual abuse.

Child reports sexual activities to a friend, classmate, teacher, friend’s mother, other trusted adult.
Child wears torn, stained, bloody under clothing.
Injury/disease is unusual for specific age group.
Young girl is pregnant or has sexually transmitted disease. Not stand alone, but coupled with other information could be cause for concern.

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BEHAVIORAL INDICATORS

-Drastic behavioral changes.

-Running away from home, becoming aggressive, depressed or delinquent behavior.

-Frequent absences, sudden drop in school performance.

-Fearful of home, withdrawn, substance abuse, suicidal.

-Inappropriate understanding of sexual behavior according to age.

-Unusual, aggressive or inappropriate sexual behavior with peers or toys.

-Compulsive indiscreet masturbation.

-Excessive curiosity about sexual matters or genitalia.

-Coercion, force or pain in putting something in genitals of self or another child.

Older Children

Younger Children

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CULTURAL AWARENESS

“Cultural and religious child rearing practices and beliefs which differ from the general community standards shall not in themselves create a need for child welfare services unless the practice presents a specific danger to the physical or emotional safety of the child.”

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WHAT IS NOT CHILD ABUSE?

Injuries caused by children fighting by mutual consent

Children Fighting

Injuries caused by reasonable and necessary force used by a peace officer acting within the scope of employment
Injuries caused by force used by public school personnel to stop disturbance threatening someone’s safety

Reasonable Force

Spanking not abuse unless cruel or inhumane, resulting in injury, or traumatizing the child

Corporal Punishment

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NOT CHILD ABUSE (CONT.)

Informed and appropriate medical decision and treatment by spiritual means is not considered neglect
Read Addendum I Penal Code

Medical Treatment

Voluntary between children under the age of 14

Sexual Activity

Unless female under age 16 and male over age 21.

Pregnancy

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NOT CHILD ABUSE (CONT.)

Past Abuse

If adult discloses abuse that occurred as a child, does not need to be reported

Only when another child under the age of 18 may still be affected by abuser

Maternal Substance Abuse

Positive toxicology screen at birth is not enough basis for reporting as abuse/neglect.

Report must be made if other risk factors are present

Sudden Infant Death Syndrome

Not caused by child abuse or neglect; unexplained medical mystery discovered through autopsy

Normally nothing the parent could have done to save child

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QUIZ TOPICS

Cultural beliefs/practices

Student Learning Outcome

Risk factors for child abuse/�neglect

Universal characteristic of abuser profile

Syllabus