Child Abuse

IX. Determining Abuse: How to Tell Whether a Child Is Abused or Neglected

There are two primary ways of identifying children who are abused: spotting and evaluating physical injuries, and detecting and appraising developmental delays. Distinguishing physical injuries due to abuse can be difficult, particularly among younger children who are likely to get hurt or receive injuries while they are playing and learning to become ambulatory. Nonetheless, there are several types of wounds that children are unlikely to give themselves during their normal course of play and exploration. These less likely injuries may signal instances of child abuse.

While it is true that children are likely to get bruises, particularly when they are learning to walk or crawl, bruises on infants are not normal. Also, the back of the legs, upper arms, or on the chest, neck, head, or genitals are also locations where bruises are unlikely to occur during normal childhood activity. Further, bruises with clean patterns, like hand prints, buckle prints, or hangers (to name a few), are good examples of the types of bruises children do not give themselves.

Another area of physical injury where the source of the injury can be difficult to detect is fractures. Again, children fall out of trees, or crash their bikes, and can break limbs. These can be normal parts of growing up. However, fractures in infants less than 12 months old are particularly suspect, as infants are unlikely to be able to accomplish the types of movement necessary to actually break a leg or an arm. Further, multiple fractures, particularly more than one on a bone, should be examined more closely. Spiral or torsion fractures (when the bone is broken by twisting) are suspect because when children break their bones due to play injuries, the fractures are usually some other type (e.g., linear, oblique, compacted). In addition, when parents don’t know about the fracture(s) or how it occurred, abuse should be considered, because when children get these types of injuries, they need comfort and attention.

Head and internal injuries are also those that may signal abuse. Serious blows to the head cause internal head injuries, and this is very different from the injuries that result from bumping into things. Abused children are also likely to experience internal injuries like those to the abdomen, liver, kidney, and bladder. They may suffer a ruptured spleen, or intestinal perforation. These types of damages rarely happen by accident.

Burns are another type of physical injury that can happen by accident or by abuse. Nevertheless, there are ways to tell these types of burn injuries apart. The types of burns that should be examined and investigated are those where the burns are in particular locations. Burns to the bottom of the feet, genitals, abdomen, or other inaccessible spots should be closely considered. Burns of the whole hand or those to the buttocks are also unlikely to happen as a result of an accident.

Turning to the detection and appraisal of developmental delays, one can more readily assess possible abuse by considering what children of various ages should be able to accomplish, than by noting when children are delayed and how many milestones on which they are behind schedule. Importantly, a few delays in reaching milestones can be expected, since children develop individually and not always according to the norm. Nonetheless, when children are abused, their development is likely to be delayed in numerous areas and across many milestones.

As children develop and grow, they should be able to crawl, walk, run, talk, control going to the bathroom, write, set priorities, plan ahead, trust others, make friends, develop a good self-image, differentiate between feeling and behavior, and get their needs met in appropriate ways. As such, when children do not accomplish these feats, their circumstances should be examined.

Infants who are abused or neglected typically develop what is termed failure to thrive syndrome. This syndrome is characterized by slow, inadequate growth, or not “filling out” physically. They have a pale, colorless complexion and dull eyes. They are not likely to spend much time looking around, and nothing catches their eyes. They may show other signs of lack of nutrition such as cuts, bruises that do not heal in a timely way, and discolored fingernails. They are also not trusting and may not cry much, as they are not expecting to have their needs met. Older infants may not have developed any language skills, or these developments are quite slow. This includes both verbal and nonverbal means of communication.

Toddlers who are abused often become hypervigilant about their environments and others’ moods. They are more outwardly focused than a typical toddler (who is quite self-centered) and may be unable to separate themselves as individuals, or consider themselves as distinct beings. In this way, abused toddlers cannot focus on tasks at hand because they are too concerned about others’ reactions. They don’t play with toys, have no interest in exploration, and seem unable to enjoy life. They are likely to accept losses with little reaction, and may have age-inappropriate knowledge of sex and sexual relations. Finally, toddlers, whether they are abused or not, begin to mirror their parents’ behaviors. Thus, toddlers who are abused may mimic the abuse when they are playing with dolls or “playing house.”

Developmental delays can also be detected among abused young adolescents. Some signs include the failure to learn cause and effect, since their parents are so inconsistent. They have no energy for learning and have not developed beyond one- or two-word commands. They probably cannot follow complicated directions (such as two to three tasks per instruction), and they are unlikely to be able to think for themselves. Typically, they have learned that failure is totally unacceptable, but they are more concerned with the teacher’s mood than with learning and listening to instruction. Finally, they are apt to have been inadequately toilet trained and thus may be unable to control their bladders.

Older adolescents, because they are likely to have been abused for a longer period of time, continue to get further and further behind in their developmental achievements. Abused children this age become family nurturers. They take care of their parents and cater to their parents’ needs, rather than the other way around. In addition, they probably take care of any younger siblings and do the household chores. Because of these default responsibilities, they usually do not participate in school activities; they frequently miss days at school; and they have few, if any, friends. Because they have become so hypervigilant and have increasingly delayed development, they lose interest in and become disillusioned with education. They develop low self-esteem and little confidence, but seem old for their years. Children this age who are abused are still likely to be unable to control their bladders and may have frequent toileting accidents.

Other developmental delays can occur and be observed in abused and neglected children of any age. For example, malnutrition and withdrawal can be noticed in infants through teenagers. Maltreated children frequently have persistent or untreated illnesses, and these can become permanent disabilities if medical conditions go untreated for a long enough time. Another example can be the consequences of neurological damage. Beyond being a medical issue, this type of damage can cause problems with social behavior and impulse control, which, again, can be discerned in various ages of children.

X. Determining Abuse: Interviewing Children

Once child abuse is suspected, law enforcement officers, child protection workers, or various other practitioners may need to interview the child about the abuse or neglect he or she may have suffered. Interviewing children can be extremely difficult because children at various stages of development can remember only certain parts or aspects of the events in their lives. Also, interviewers must be careful that they do not put ideas or answers into the heads of the children they are interviewing. There are several general recommendations when interviewing children about the abuse they may have experienced. First, interviewers must acknowledge that even when children are abused, they likely still love their parents. They do not want to be taken away from their parents, nor do they want to see their parents get into trouble. Interviewers must not blame the parents or be judgmental about them or the child’s family. Beyond that, interviews should take place in a safe, neutral location. Interviewers can use dolls and role-play to help children express the types of abuse of which they may be victims.

Finally, interviewers must ask age-appropriate questions. For example, 3-year-olds can probably only answer questions about what happened and who was involved. Four- to five-year-olds can also discuss where the incidents occurred. Along with what, who, and where, 6- to 8-year-olds can talk about the element of time, or when the abuse occurred. Nine- to 10-year-olds are able to add commentary about the number of times the abuse occurred. Finally, 11-year-olds and older children can additionally inform interviewers about the circumstances of abusive instances.

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