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November 30, 2013 at 9:36 PMComments: 1 Faves: 0

Know the Signs of Child Abuse and Neglect

By Jeffrey VanWingen M.D. More Blogs by This Author

Every year about this time I take a portrait of my four children.  This year as I gaze upon the faces of my kids,  I notice how they've grown and matured.  I see their personalities in the nuances of the way they hold their smiles-- the subtle things a parent would appreciate.  I also marvel at how fortunate I am to have these kids.  Beneath the niceties, however, is a burden that I face having seen too much in my job, even thinking of happenings this week.   My thoughts tend to darken when I think about how much I love my kids and how easily children out there fall victims to abuse.  And while not much causes me to lose my demeanor, any harm to my children would cause me to come unglued.  Yes, as I have kids and as I see that the statistics are true regarding child abuse, I am passionate about it.  Like a person learns CPR or memorizes the number for poison control, the symptoms of child abuse should be known-- it could save a life.

The statistics

Each year reports of child abuse or neglect are filed for more than six million children.  An average of over four children die each day as a result of abuse.  Abuse happens among all ethnic, racial and socioeconomic classes.  As an industrialized nation, the US does not fare well having one of the highest rates.  Of the fatalities, 80% were under four years of age.  81% of perpetrators were a close contact of the child (family, caregiver, friend).  Slightly more than half of perpetrators were women vs. slightly less than half being men.

The challenges of identifying child abuse

Child abuse has been called "the hidden epidemic."  While it is definitely prevalent, barriers exist, making it difficult to bring it out into the open.  First, children are readily revealing of abuse.  Small children lack communication skills.  Children may lack a sense of right from wrong, not knowing that wrong-doing has occurred.  Children may feel ashamed or even blame themselves for the abuse.  Symptoms may be obscure and misread by adults.  Finally, adults second guess the signs and their intuition.  Or, they may succumb to the stigma and sweep things under the rug.

Physical abuse symptoms in children

Unexplained bruises on a child's skin should raise suspicion.  While bruises on a child's shin do not raise concern, significant bruising on the buttocks, upper arm or face should prompt suspicion.  The shape of bruising is also important.  Hand prints on the arm, torso or buttocks are concerning.  Linear bruising may indicate beating with an object.  Timing is also important.  Bruises of different ages could be significant.

Behavior indicators by children bringing out suspicion can be difficult as their minds work in different logic than ours.  Any report by a child that they have been abused needs to be taken seriously.  Children may make up unbelievable explanations for their injuries.  A significant and sudden change in behavior should raise concern, especially if the child becomes withdrawn or aggressive.  Fear in going home is concerning.  Remember also, that a bully at school may be a product of getting bullied elsewhere such as the home. 

Neglect symptoms in children

Neglected children appear consistently lacking.  They do not keep commitments and may be late to commitments.  Grooming may also be problematic with poor hygiene or clothes that do not fit.  They may be poorly dressed for the weather conditions.  They may be hungry or display food seeking behavior.  Neglected teens may run away or drop out of school.  They may turn to drugs, alcohol or other risk-taking behaviors. 

Sexual abuse symptoms in children

Any reports of sexual contact between a child and an adult must be taken seriously.  Any reports of a child being shown genitalia or pornography is abuse until determined otherwise by a professional.  Frequent "somatic" complaints such as headache, stomach ache, or fatigue may provide non-specific clues that something is going on.  Extreme modesty or regression in behaviors (bed wetting, phobias) may raise suspicions.  Unexplained bruising, scrapes or rash around the genitalia is another red flag.  Seductive or advanced sexual behavior is also reason for concern.

How should you respond?

Intuition should not be second guessed provided that intentions are good and no motives exist.  The quicker that abuse or neglect is addressed, the better the outcome.  The benefits are not only for the children involved but their legacy.  Abused or neglected children are 11 times more likely to engage in criminal behavior.  One third of abused children will go on to be abusers themselves if not treated with love and anticipatory guidance in this regard. 

If you do respond, tread carefully.  Do not attempt to solve these issues on your own.  Trained professionals in Child Protective Services and other agencies have training to deal with these sensitive situations objectively.  Further, they are experts at collecting evidence.  Sadly, many physical and sexual abuse cases have been thrown out in court because of poor evidence gathering and poor interviewing of children.  It is easy to put words or notions into a child in trying to obtain their story.  As an untrained professional, concerned person, our job is simply to report to our local agency.  Citizens have a moral obligation to report concerns while professionals (teachers, healthcare workers, therapists) have a moral and a legal obligation.

In conclusion...

Child abuse is a hidden epidemic.  Sadly, many cases of child abuse occur unrecognized and unreported.  When this occurs, children are placed in physical and emotional danger.  Further, unaddressed abuse tends to perpetuate as an unfortunate legacy.  Knowing the signs of abuse can help to identify this horrible perpetration of the rights of society's little ones.

You may access your local Child Protective Services at .


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1 Comment

  • Sexual abuse can't happen in my family. Yes!!! it can, unfortunately. He is 5 yrs old. He started having increased energy. He didn't stop! He's a boy, right. Open your eyes to the possibility that something else is going on here. He had an "itch", normal right, overlooked as a bath issue. Then, weeks after the occurrence happened the truth was revealed. Guilt, of course. As diligent as you can be, unfortunately, it can and does happen and yes, it was with "friend". Dr. VanWingen's article is informative and well worth the read.

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