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What is Child Abuse?What is Child Abuse?
Profile of an Abusive Home
What is Child Abuse? The California Definition
- A child is a person who has not attained the age of 18.
- Any act of omission or commission that endangers a child’s physical or emotional health and development.
What is Child Abuse? The Federal Definition
- A child is a person who has not attained the age of 18.
- At a minimum, any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation.
- At a minimum, an act or failure to act which presents an imminent risk of serious harm?
To many, child abuse is narrowly defined as having only physical implication. In reality categories of child abuse includes:
- Physical abuse; unlawful corporal punishment or injury.
- General and severe neglect.
- Emotional abuse
- Sexual abuse; sexual assault; exploitation.
- Willful cruelty or unjustifiable punishment; emotional maltreatment.
Child abuse may involve multiple categories. They include both acts and omissions. Competent interventions must consider evaluating multiple categories of abuse. The act of inflicting injury or the failure to act so that injury results, rather than the degree of injury, is the basis for making the decision to intervene.
Physical Abuse—California Penal Code Section 11165.3-11165.6
Physical Abuse is defined as physical injury inflicted on a child by other than accidental means to include but not limited to the following:
- Willful cruelty or unjustifiable punishment of a child where a person willfully causes or permits any child to suffer, or inflicts thereon unjustifiable physical pain or mental suffering.
- When a person willfully causes or permits the person or health of the child to be placed in a situation such that this or her person or health is endangered.
- Unlawful cruel or inhumane corporal punishment resulting in a traumatic condition.
Physical Abuse—Federal Guidelines
- Physical injury as a result of punching, beating, kicking, biting, burning, shaking or otherwise harming a child.
- The parent or caretaker may not have intended to hurt the child; rather the injury may have resulted from over-discipline or physical punishment.
The Four Distinct Characteristics of Non-Accidental Injuries
- Location of the injury
- Pattern of the injury
- Correlation of the story to the injury
- Degree or extent of the injury
Location of the Injury
Injury from abuse is most often located on the following areas:
- Head and neck area (This area is vulnerable to injury because of a child’s small stature...it may the closest body part to an adult’s hand or fist. Also, it is often targeted as it is where the crying, back talk, sass, bad language, etc. is emanating from. The area of the head covered by hair may be targeted as the hair covers any bruising or lumps).
- Hands are targeted as they are actively exploring or “getting into things”
- Upper arms
- Front and backs of thighs
- Genital area
"Normal" childhood injuries are typically located on areas where the skin is close to the bone, such as:
- Lower arms
Pattern of the Injury
- Injury or bruises in a pattern which reflects the object used - a belt buckle, a handprint (the hand is the most common object used), knuckles, bottom of an iron, etc.
- Frequency of and/or recurrent injuries to the same site - child abusers often injure their victim in the same manner or use the same implement
- Clustered bruises
- Human bite marks - this might be found in sexual abuse cases as well as physical abuse.
- Two black eyes - it is very unusual to have two black eyes unless you have been in a car accident, or have broken your nose
Correlation of the Story
- The parent and/or child tell conflicting or confusing stories on how the injury occurred
- Treatment is delayed for fear of being caught
- Hospital or Doctor “hopping” to avoid suspicion because of frequent visits
- County “hopping” to avoid CPS intervention
- School “hopping” to avoid suspicion from school personnel
- Poisoning, especially in children under 6 months and over 6 years of age - children over six generally “know better” and children under 6 months are not “mobile.”
Conditions That Could Be Mistaken for Child Abuse
- Children with hemophilia, low blood platelet count or Leukemia tend to bruise easily.
- A birth mark (sometimes call Mongolian Spot) is a deep purple/bluish/grayish birthmark which looks like a bruise. They can be anywhere on the body, but typically are on the buttocks and lower back. Mongolian spots are commonly found in African Americans, Asians and Hispanics.
- Impetigo is a skin condition with sores that look like crusty, healing burns.
General Indicators of Physical Abuse
- Indication of abuse often remains on the body
- If a child discloses that abuse is/has occurred, it should be taken seriously
- Any injury which is unusual for child’s age or development
- Shaken Baby Syndrome
- Retinal Hemorrhage
- Unexplained vision or hearing problems
- Lacerations/abrasions which are not regular childhood-type injuries
- Skeletal injuries and/or multiple fractures on different parts of the body
- Internal or abdominal injuries
- Absence of hair due to pulling
- Injuries from pulling or twisting
- Injuries in various stages of healing
- Moves stiffly or gingerly
- Bruises in various stages of healing
- Bruises that regularly appear after absences, weekends or vacations.
- Bruises of any kind on an infant, especially on the face and buttocks
- Clustered bruises
- Bruises reflecting the shape of the object used, such as the hand, belt buckle,
- Burns in unusual places such as the soles of feet, palms of hands, buttocks, etc.
- Perfectly round burns the size of a cigarette tip or car lighter.
- Burns reflecting the pattern of the electrical appliance used, such as BBQ starter.
- Rope burns on limbs, neck or torso
Scalding burns are the most common. Deliberate immersion burns will leave distinct waterlines such as:
- Burns resembling sock-like or mitten-like markings on the hands or feet
- “Doughnut” burn pattern on the buttocks - the child was pressed against in the bottom of the tub so forcibly, water doesn’t come in contact with the center part of the buttock A child accidentally falling into scalding water would have splash or irregular shaped burns, not distinct lines
- No burns in areas where the child has “flexed” in reaction to what was happening, I.e., arms tightened and folded against body, folds in the stomach, thighs against abdomen.
- Scalding burns on the back - child was probably trying to run away from perpetrator.
Behavioral Indicators of Physical Abuse
- Child is uneasy or frightened when discussing injury
- Parent or child is overly passive or aggressive
- Child overly afraid or protective of parent
- Lags in development
- Bullies other children to “get even’ with the world
- Constantly alert to danger
- Runs away
- Head banging
- Extreme or inappropriate reaction to pain
- Destructive behavior toward self and others
- Inappropriate dress to hide injury
- Chronic absence or tardiness in school
- Arriving early and leaving late from school to avoid going home
- Wary of physical contact
- Parent may send child to school with the subconscious hope that someone will recognize the problem
- Parent responds inappropriately to the seriousness of the problem
- Parent hostile or antagonistic when talking about the problem
Sexual Abuse and Exploitation—California Penal Code Section 11165.1
Sexual abuse is defined as sexual assault or sexual exploitation of a minor, it includes but limited to the following:
- Statutory Rape
- Gang Rape (Rape in Concert)
- Oral Copulation
- Lewd and Lascivious Acts
- Child Molestation
- Penetration of the genital or anal opening, no matter how slight, by any object or body part whether or not there is the emission of semen. This does not include acts performed for a valid medical reason.
- Sexual contact between the genitals or anal opening of one person and the mouth or tongue of another person.
- Touching of genitals or intimate body parts or the clothing covering them for the purpose of sexual arousal or gratification. This does not include acts which are normal caretaker responsibilities or for a valid medical purpose.
- Masturbation in the presence of a child.
- Preparing, selling or distributing child pornography.
- Child prostitution or a live performance involving obscene sexual conduct with a child.
Sexual Abuse and Exploitation—Federal Guidelines
- The employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct.
- The rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children.
General Indicators of Sexual Abuse
- Child reports abuse - this is a big, bold, scary step for the child to take in breaking out of the “conspiracy of silence” and should be taken very seriously.
- Sexualized behavior, curiosity, or knowledge inappropriate for age
- Torn, stained or bloody undergarments
- Sexually transmitted diseases
- Genital discharge or infection
- Trauma or injury to genital or anal area
- Difficulty in walking, sitting urination or defecation due to genital or anal pain
- Excessive/compulsive masturbation
- In boys, excessive concern about homosexuality or homophobia
- Sexual victimization of other children
- Self-destructive behavior or suicide threats
- Withdrawal or depression
- Sudden acquisition of money, clothes or gifts
- Animal abuse
- Fire setting
Indicators in Younger Children
- Bed and pants wetting or fecal soiling
- Eating disturbances
- Unusual fears or phobias
- Overly compulsive behavior
- Change in school performance
- Pseudo-maturity or regressive behavior
- Inability to concentrate
- Sleep disturbances
- Frightened of caretaker or of going home
Indicators in Older Children and Teens
- Chronic fatigue, depression or apathy
- Excessive bathing
- Purposefully making themselves unattractive through poor hygiene
- Poor peer relations and social skills
- Overly compliant, aggressive, antisocial or delinquent behavior
- Running away
- Alcohol or drug use
- Prostitution or promiscuity
- Inappropriately seductive behavior
- Unusual fear of pelvic exams
- Drop in school performance
- Chronic absence or tardiness
- Arrives early at school and stays late to avoid being home
- Refusal to dress for P.E.
- Non-participation in activities
- Fearful of showers or restrooms
- Fearful of home life
- Fearful of males
- Overly self-conscience of body
- Crying without provocation
- Fire setting
- Eating disorders
- Early marriage to avoid abusive situation
Behaviors that MAY be seen in a Sexually Abusive Person
- Drug or alcohol abuse or other addictive behavior
- Mood changes
- Last to go to bed, or up during the night
- Sexual preoccupation
- Views child pornography
- Seeks out relationships with children over adults
- Erratic discipline
- Prolonging physical contact with children…wrestling, tickling, bathing
- Walks in on child while bathing or using the toilet
- Interferes with child’s normal friendships
- Relates to the child with sexual undertones or manner
Why does the non-abusing parent often look the other way?
- They maybe in denial that their partner is capable of doing such a thing
- They may have been sexually abused as a child
- They may fear the loss of their partner or financial stability
- They may fear reprisal from partner for confronting the situation
Physical Neglect—California Penal Code Section 11165.2
Physical neglect is defined as negligent treatment or the maltreatment of child by a person responsible for the child’s welfare, including both acts and/or omission of care.
General neglect is the unwillingness of the parent or caretaker to provide for adequate basic needs, where there is no physical injury or injury is not likely to occur for example:
The failure to provide adequate:
- Medical, dental or psychiatric care
Severe neglect is the unwillingness of the parent or caretaker to provide for adequate basic needs, where there is physical injury or injury is likely to occur, such as:
- Non-organic failure to thrive
- Chronic neglect
- Willful endangerment
- Refusal to seek medical care for serious conditions
Physical Neglect—Federal Guidelines
- Neglect can by physical, educational, or emotional.
- Physical - refusal of or delay in seeking health care
- Educational - chronic truancy, failure to enroll in school, failure to attend to special educational needs.
- Emotional - inattention to the child’s need for affection, refusal of or failure to provide needed psychological care, spousal abuse in the presence of the child, permission to use drugs or alcohol by the child
- Assessment of child neglect needs consideration for cultural values and standards of care as well as failure to provide may be related to poverty.
Examples of Physical Neglect
Children not being fed:
- No food available
- Food intentionally withheld
- Children complain of hunger
- Children beg or steal food
Lack of adequate shelter:
- Hazardous conditions (exposed wiring, broken glass)
- Unsanitary conditions (garbage, spoiled food, excrement)
- Lack of plumbing or other utilities
- Homelessness where there are significant risk factors that place the child in imminent danger
Lack of Supervision
- Children left in the care of children who are unable to care for them
- Any child left without supervision who is at risk due to age, environmental risks or personal limitation, especially those under age 8
- Truancy issues should be referred to the school district
Lack of Adequate Clothing/Personal Hygiene
- Clothing inadequate or inappropriate for weather
- Persistent skin disorders or severe diaper rash due to improper hygiene
Lack of Medical or Dental Care
- Untreated injuries
- Failure to comply with medical treatment, posing a risk to the child’s health
- Chronic lice with scabbing or secondary infection
- Failure to thrive
- Lack of attention to serious dental problems
Failure to Protect
- Failure of parent or caretaker to protect child from known situations of child abuse in any of its forms
Behavioral Indicators of Physical Neglect
- Hoards food
- Infantile behavior
- Delayed developmentally
- Poor growth pattern or obesity
- Extremes in behavior
Emotional Abuse—California Penal Code Section 11166&b;
Emotional abuse is defined as when a person causes or permits a child to suffer unjustifiable or significant mental suffering.
Emotional Abuse—Federal Guidelines
- Acts or omissions by parents or caretakers that have caused, or could cause, serious behavioral, cognitive, emotional or mental disorders.
- Some acts, do not leave evident harm to the child but warrant reporting, such as extreme or bizarre forms of punishment, such as locking a child in a closet.
- Emotional abuse is almost always present when other forms of abuse are identified
- Name calling
- Unpredictable responses
- Child exposed to domestic violence
- Isolation of the child from social contacts
- Deliberate withholding of love and affection
- Child placed in restraints, caged or severe confinement
Indicators of Emotional Abuse in the Child
- Withdrawn, seeks isolation or is unresponsive
- Overly rigid or passive
- Repetitive, rhythmic movements
- Sleep, eating or speech disorders
- Learning problems
- Destructive to self or others
- Poor self-image and esteem - may unwittingly say “I’m bad…my daddy tells me so.”
- Hungers for attention and affection
- Failure to Thrive Syndrome
Indicators of Emotional Abuse in the Parent
- Has unrealistic expectations of the child - developmentally, educationally or emotionally
- Enforces unusual penalties or vaguely sinister punishment - it is one thing to place a child in time-out in their room for five minutes, and another to place a child in time-out in a locked closet for five minutes
- Uses child to satisfy their own ego needs
- Describes the child as bad, different, worthless or evil
- Refers to the child as “It”
- Uses child as a battleground for problems
Cultural Customs can be mistaken for forms of child abuse. If you suspect child abuse or are uncertain if a child is being abused because of cultural differences, report it so that authorities can determine if a child is being abused.
There are some cultural customs used as home remedies to cure or relieve the symptoms of some ailments such as:
- Itchy skin
- Flu Symptoms
These practices are primarily seen in Southeast Asian cultures, but some are also used by Russian immigrants and Mexican-American families.
These practices are usually performed by a trained practitioner.
From culture to culture, these remedies have different names and the process differs slightly.
These are some of the healing practices used which leave marks on the body and may be confused with child abuse.
- Coining is one of the most commonly practiced remedy methods.
- The chest, back, shoulders and neck are massaged with a medicated ointment such as Ben-Gay.
- The skin is then "rubbed" in a downward, linear fashion with the edge of a copper coin, or silver spoon until dark lines appear.
- This treatment leaves marks for several days which gives the appearance of having been struck with a stick or whip.
- The lines, or what appears to be bruising, is due to blood coming to the surface of the skin, from the heat and pressure of the coin being rubbed on the body.
- Cupping is performed on the chest, back, abdomen, and/or back of legs for pain, and the forehead and temples for headaches.
- The inside of a glass container or cup, about the size of a baby food jar, is lightly coated with rubbing alcohol.
- The glass is held upside down, and a lit match, candle or lighter is held under it in order to burn off the oxygen. This creates a vacuum.
- The cup is quickly placed on the skin and the vacuum effect draws the skin up.
- Blood is drawn to the surface of the skin and a round mark is left which might look like a bruise.
- These marks may remain on the body for several days.
Two Cultural Practices Which Should be Reported
- Stick Burns and Moxibustion
- Hair Pulling
Stick Burns and Moxibustion
These remedies and other similar remedies are used in certain cultures to relieve a variety of symptoms such, as fever and abdominal pain.
- These are related to acupuncture; however, they cause a circular, cigarette-tip size burn.
- A stick, similar to an incense stick is lit, and placed on the palms of the hands, soles of the feet and genital area. In some cultures, a hollow bamboo stick stuffed with cotton is lit and then extinguished.
- Moxa herbs or yarn are rolled into a pea-sized ball and placed on the skin. The ball is then lit and allowed to burn to the point of pain.
- It should be reported so that the caretaker may be educated on what are acceptable practices and alternative treatments.
This home remedy is to relieve headache pain. The hair is pulled, and if too much force is used, the hair may be pulled out of the scalp
Profiles of Homes With Child Abuse
There is no one single cause of child abuse, but there are certain common factors often present among the families where abuse occurs. This section discusses some of the common features of the homes, children and perpetrators of child abuse. This does not mean these factors are always present, or that if they are present, they will always lead to abuse.
Profile of Homes Where Children Were Killed
- Perpetrators most often male
- AFDC main source of support
- Caretakers not married to each other
- Drug or alcohol use
- Criminal history that includes a violent crime
- Victim was youngest sibling
- Domestic violence in house
- Previous abuse of the child
Deaths Caused by Child Abuse
- Head trauma is the leading cause of death in child abuse, followed by internal organ injuries.
- In most cases of internal organ injuries, there are not external signs of trauma. This is due to the pliability of the abdominal wall and its ability to absorb trauma without showing bruises.
Child Death Review Teams in Colorado and Oregon have identified some "triggers" that occurred just before many children's death from abuse
- Infant's inconsolable crying
- Feeding difficulties
- Failed potty training
- Parents have exaggerated view of "disobedience"
Common Features in Homes with Abuse
Abuse is a form of power:
- The more powerful abuses the less powerful
- Compensates for the feeling of parental impotence
- Perceived way of regaining control
- Brainwashing is used to control or manipulate the victim and to skew their view of reality
Who is a Child Abuser?
- Has been abused as a child - a life pattern of aggression and violence has been established.
- Can be found in all cultural, ethnic occupational, religious and socio-economic groups and sexes
- Has expectations too high for the child's age
- May be angry with the child
- Does not know the best way to discipline the child
- Uses abuse as a form of power
- Not satisfied with child's schoolwork
- Has problems with employer or mate
- Has financial troubles
- Has a history of violence
- May be immature
- Has a cynical and distrustful personality
- May be impulsive
- May be isolated
- Unhappy with themselves
- Has drug or alcohol addiction
- Feels justified in their action or feels it was appropriate
- May be depressed or have mental health problems
- Possesses few coping skills
- Wants personal satisfaction over seeing to child's needs
- May be a pedophile
- Lives near or below poverty level
High Risk Children and Homes
- Children born to adolescent mothers
- Unplanned or unwanted pregnancy
- Physically or mentally disabled children
- Children in a chaotic or crowded household
- Large families with children close in age
- Children born prematurely
Being a Battered Child Means...
- Hoping that maybe they'll be in a good mood, but knowing you couldn't trust them even if they were.
- Hoping that you can "just once get through breakfast and off to school" without any altercations.
- Hoping no one will notice the stitches and black eye you have tried to hide with your hair.
- Wanting to be "as good a bike rider as the rest of the kids," but still rehearsing the "self-conscious" laugh you will present with the explanation that you hurt your arm by falling off your bike.
- Hoping that someone will care enough to believe the incessant explanations you offer to account for your injuries.
- Feeling that everything will be all right, "if only…"
- Teachers like you because you are so well-behaved.
- The kids don't like you because the teacher does, and you don't know how to play anyway.
- Never knowing the consequence of a gesture, facial expression or request. Sometimes a gift of flowers is received affectionately, and sometimes it's dashed down with a shove and a tirade of abuse. Sometimes the request for a piece of gum is a "good idea" and sometimes it's proof of your horrid greediness and incorrigible lack of concern. Sometimes you are berated and punished for being selfish and ungrateful. But you just never know…
- Always worrying that when you are away from home something might be happening to your brother or sister.
- Trying to find a safe explanation for why you never bring your friends home.
- Trying to figure out what you did to "deserve" to be born into the family situation you were born into, and trying desperately to be a good person who doesn't deserve the abuse you keep getting.
- Being careful not to cry, or laugh too loudly.
- Feeling guilty that you are such a burden to your parents and sorry you were ever born, and "knowing" they feel the same way too.
- Hoping maybe they adopted you, and you could find your "real" parents and convince them you'd be good if only they'd take you back, but worrying about who would take care of your current parents if you were rescued.
- Lying awake at night listening to a brother or sister crying, and feeling sad, but wishing they would cry a little more softly so they won't "get it" again, and feeling guilty that they "got it" and not you.
- Somehow feeling your parents could love you if only you were sorry enough.
- Living in constant fear that you, or one of your brothers or sisters will be killed.
- Hoping the doctor won't believe your parents' explanation about how you got hurt, but knowing she/he probably will.
- Feeling betrayed by the non-abusing parent's failure to protect you, but trying to let them know it's all right, you understand, you know they can't help it.
- Wishing the problem was alcoholism or a chemical imbalance, so that the problem could be "cured."
- Developing your sensitivity so as to intuit threatening mood changes, but more often feeling that the heightened sensitivity is more painful than helpful.
- Wishing they could just touch you or hold you without hurting you, but sensing that they really need to be held too.
- At times hating them savagely, but soon reduced to tears because you know 'they didn't mean to," or 'they're just having a bad day," or "you should have been more careful," or…
- Wishing there was someone gentle who cared, that you could talk to, but knowing that if the subject ever came up, you would defend them loyally, because they're your parents and you love them, and you need to believe that they love you too…