Pediatrics Common Questions, Quick Answers

Child Abuse

Donna D'Alessandro, M.D.
Lindsay Huth, B.A.
Peer Review Status: Internally Reviewed
Creation Date: June 2002
Last Revision Date: June 2002

• What is child abuse?
• What are the physical signs?
• What are the behavioral signs?
• Who can be abusive?
• What should I do if I think a child is being abused?
• How is it treated?
• How can I protect my child?
• When should I call the doctor?

What is child abuse?

• There are four kinds of abuse:
  • physical abuse: hitting, throwing, burning, tying up a child, shaking a baby, or other ways of physically hurting her.
  • emotional abuse: ignoring a child, scaring her on purpose, making her feel worthless or guilty, etc.
  • sexual abuse: touching or kissing her private parts, forcing her to undress or have sex, taking pornographic pictures of her, etc.
  • physical neglect: starving a child, locking her in a closet, leaving her unsupervised for periods of time, not taking care of her when she is sick, etc.
• Every kind of child abuse is against the law.

What are the physical signs?

• All children get scratches and bruises from normal play and falls. Not all children with bruises, burns, etc. are being abused.
• Not all children who are abused show physical signs of abuse. Look for other signs of abuse as well.
• Not all children with these signs are being abused. These are sometimes signs of abuse:
  • Bruises
  • Bruises in different stages of healing
  • Bruises on the face, lips, mouth, back, bottom, thighs, or genitals
  • Bruises in the shape of a belt buckle, electrical cord, or other item that can be used to hit a child
  • Bruises after a child has been absent from school or daycare
  • Black eyes
  • Broken bones
  • Cigar or cigarette burns (especially on hands, feet, back, or bottom)
  • Burns that look like a child's hand, foot, etc. was held under hot water
  • Burns in the shape of hot items, such as a cigarette lighter, iron, etc.
  • Rope burns
  • Other unexplained burns
  • Child has difficulty walking or sitting
  • Torn or bloody underwear
  • Pain with urination or has to go to bathroom often
  • Sexually transmitted diseases (STDs)
  • Swollen, red, or itchy genital area (or discharge from genital area)
  • Frozen stare
  • Always has a stomach ache or vomiting
  • Fails to gain weight, loses weight
  • Dirty clothes, clothes that are not right for the weather
  • Child does not get medical or dental care when needed
  • Wetting pants even if potty trained

What are the behavioral signs?
An abused child may not show these behavioral signs until years after the abuse has happened. If you suspect a child is being abused, look for these signs but keep in mind that children under stress (from parents divorcing, a move, or other life-changing event) also may show these symptoms:

• Low self-esteem
• Sexually acting out
• Does not trust others
• Aggressive, angry
• Disruptive
• May do things that are illegal
• Self-destructive (does things to hurt herself or her future)
• Talks about suicide
• Withdrawn, doesn't make friends, doesn't like affection or being close to others
• Fearful of new people and activities
• Has trouble with schoolwork
• Worry, anxiety, sadness, depression
• Nightmares
• Drug or alcohol abuse
• Avoids going home after school
• Is fearful of certain adults
• Often thinks she deserves to be punished
• Is scared when other children cry
• Daydreams
• Infants who lie very still while looking all around
• Knows more about sex than she should for her age
• Often rubs or scratches the genitals
• Is always looking for affection, tries to please
• Sleeping or eating problems
• Talks about having a secret
• Acting much younger than her age
• Self-injury
• Unusual habit (sucking, biting, rocking)

Who can be abusive?

• Any person can abuse a child; a man, woman, teenager, girlfriend, teacher, etc.
• A person of any age, gender, race, or class can be abusive.
• An abusive person may avoid parents or co-workers.
• An abusive person may avoid school and work activities.
• An abusive person may seem uncomfortable talking about the child's injuries or problems. (They may have strange or unbelievable explanations for the child's bruises. Their explanations may be different from the child's.)
• An abusive person may have been abused as a child.
• The person may abuse drugs or alcohol.
• The person may be isolated (have few family, friends, or other support group).
• The person may lead a stressful life (working a lot, money problems, marital problems, etc.).
• The person may be very strict with the child. They may be hard on the child.
• The person may show very little concern for the child.

What should I do if I think a child is being abused?

• If a child starts telling you she is being abused, sit still and be a good listener. Stay calm.
• When she is done talking, ask if there is anything else she wants to say.
• Do not ask too many specific questions. It could confuse her. If your child is confused, it will be harder for police to prove she is being abused.
• Tell her she was right to tell you and that you believe her. The abuse is not her fault. Reassure her that you will protect her.
• After talking to the child, write down everything she told you.
• Take the child to the doctor for an exam, even if she looks healthy.
• Keep the child away and other children from that person or place until you know it is safe.
• If you suspect abuse, you must report it. The child's life could be in danger.
• Teachers, child-care staff, and other professionals who work with children are required by law in most states to report suspected abuse.
• Contact the police, hospital, or a local child protective services agency for help.
• Many states have hotlines that a person can call to report abuse without giving their name. Check your phonebook.
• Write down the date, time, and name of the person you reported the abuse to. Call back in a week to see what has been done.

How is the family treated?

• The whole family will likely need support if a child has been abused.
• Early treatment is best. The abused child needs immediate protection.
• The child may need therapy. Therapy can help her learn how to trust others and help her build her self-esteem.
• Parents and others who are abusive need professional help, too.

How can I protect my child?
Take steps to protect your child from abuse and teach your child how to protect herself.

For parents

• If you become angry with a child, put her in a safe place and walk away.
• Give yourself a time-out. Take deep breaths and relax. Do not go back to the child until you have calmed down.
• If possible, call a friend or relative so you can take a break.
• If your family needs help, ask. If you are stressed out, you will be less patient with your child.
• If you need help with money, housing, employment, etc., call your doctor or a social service agency for help.
• Attend a parenting class.
• Learn anger management or relaxation techniques. Ask your doctor.
• Babies with special needs demand more attention and patience. Ask friends and relatives to help out. Join a support group.
• Take care of yourself and you will be able to take better care of the child.
• Mothers who show signs of postpartum depression should see a doctor right away.
• Never shake a baby. Shaking a baby can lead to brain damage and death.
• Call the doctor, a friend, or other help if you think you might hurt a child.

For children

• Teach your child about the different kinds of abuse. Use a children's book to help you.
• Teach children that if they are ever touched or treated wrongly, they should tell a trusted adult right away.
• Children must never keep abuse a secret. Tell children that if an adult does something wrong then asks the child to keep it a secret, she should tell another adult.
• Teach kids that if an adult asks them to do something they think is wrong, it's okay to say no.
• Take your child seriously if she tells you she is being abused. Look into it even if you trust the person your child names (even if it is a spouse).

When should I call the doctor?

• If you think you have abused a child, ask a friend or doctor for help.
• If you suspect a child is being abused, call the doctor. The doctor will be able to tell you how to report it. Many states have hotlines that a person can call to report abuse without giving their name. Check your phonebook.
• Call the doctor if you have hurt a child or shaken a baby. The child or baby will need to see a doctor right away.
• Call the doctor if you have questions about abuse.

Quick Answers

• There are four kinds of child abuse: physical abuse, emotional abuse, sexual abuse, and neglect.
• An abused child may have unusual bruises, burns, or infections.
• The child may be withdrawn, disruptive, or fearful of going home.
• Abusive parents may seem uncomfortable about talking about their child's injuries.
• If you suspect a child is being abused, you must report it. The child could be in danger.
• If the child is being abused, she needs protection and may need therapy.
• Teach your child about abuse. Tell her it is never okay for someone to touch her in bad ways. She should tell a trusted adult if someone ever hurts her.

References

• American Academy of Child and Adolescent Psychiatry. Child Abuse: The Hidden Buises. URL: http;//www.aacap.org/publications/factsfam/chldabus.htm/ 1998 August (cited 2002 May 14).
• CDC. Intentional Injuries: Child Abuse. 1997 January (cited 2002 May 14). URL: http://www.cdc.gov/ncidod/hip/abc/intro5.htm
• Eller CL. Child Abuse. University of Connecticut Cooperative Extension. 1995 July (cited 2002 May 22). URL: http://www.nncc.org/Abuse/abuse.child.abuse.html
• Robins P. Recognizing Signs of Child Abuse. KidsHealth. URL: http://kidshealth.org/pageManager.jsp?dn=KidsHealth&lic=1&ps=107&cat_id=168&article_set=21925

See related Patient Topics Child Abuse, Child and Teen Health, Food, Nutrition and Metabolism, Injuries and Wounds, Preventing Disease and Staying Healthy, Social/Family Issues or Wellness and Lifestyle.

See related Provider Topics Child Abuse, Child and Teen Health, Food, Nutrition and Metabolism, Injuries and Wounds, Preventing Disease and Staying Healthy, Social/Family Issues or Wellness and Lifestyle.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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