What is child abuse and neglect?

Child abuse means doing something that hurts a child. Neglect means not giving or doing something that a child needs.

There are different types of abuse and neglect.

Physical abuse.

This includes hitting, kicking, shaking, pinching, and burning. It may leave bruises, cuts, or other marks and cause pain, broken bones, or internal injuries.

Emotional abuse.

This means saying or doing things that make a child feel unloved, unwanted, unsafe, or worthless. It can range from yelling and threatening to ignoring the child and not giving love and support. It may not leave scars you can see, but the damage to a child is just as real.

Sexual abuse.

Any sexual contact between an adult and a child or between an older child and a younger child is sexual abuse. Showing pornography to a child is a type of sexual abuse.

Neglect.

Neglect happens when a child does not get the shelter, schooling, clothing, medical care, or protection that the child needs. Child neglect is just as serious as abuse and is more common.

Child neglect means not providing a child with basic needs. A child's general appearance, home environment, and behavior patterns can show signs of neglect.

A child who is neglected may:

• Be very underweight or overweight.
• Be developmentally delayed.
• Be sick or tired most of the time.
• Be dirty or have poor personal hygiene.
• Not have the right clothes for the weather.

Here are some ways that child abuse and neglect are diagnosed.

Physical exam

An abused or neglected child who is taken to a doctor will first have a general physical exam. The doctor will review the child's medical history and ask parents or caregivers questions about the child's condition.

A child who is able to talk may be separated from the caregiver during the interview.

The law requires doctors to consider the possibility of abuse or neglect. Along with seeing signs of physical abuse or neglect, a doctor may become suspicious when:

• The injury is unusual or is not likely to be an accident, especially for the child's age.
• The parents or caregivers don't have a good explanation, or the explanation changes.
• The parents or caregivers say no one saw the injury happen.
• Medical records show that similar injuries or patterns of neglect have occurred in the past.
• The parents or caregivers put off taking the child to the doctor without a good reason.
• The doctor finds signs of sexual abuse.

Other children in the care of the same person may also be examined and have X-rays if police or doctors think it's needed.

Common tests

Tests that are often used to help confirm or rule out abuse or neglect include:

Imaging tests.

Tests such as an X-ray, CT scan, or MRI can help determine whether a child's injuries include any broken bones. Some tests may also show signs of past injuries.

Blood tests.

Blood tests can be used to look for signs of organ damage.

Urinalysis.

This test checks for blood in the urine, which can be a sign of internal injuries.

Specialized lab tests.

For example, the doctor may take skin or hair samples or samples of fluids in or around the vagina to be tested.

Lumbar puncture.

This is also called a spinal tap. It may reveal blood from a brain injury.

Eye exam.

This test is done to find out if damage has occurred that points to abusive head trauma.

Other tests

Other exams and tests depend on the specific medical problem suspected or observed. For example:

• Psychological testing may be requested for some children.
• Victims of suspected sexual abuse may be tested for sexually transmitted infections.

Tracking a child's injuries

Information about a child's injuries is carefully recorded. A detailed account of the injuries goes into the child's permanent health record.

This record usually includes photographs and drawings of the injuries.

Measurements such as weight, height, and head circumference are also taken and recorded to help establish a child's baseline growth pattern. Recording these measurements on growth charts can help identify failure to thrive that sometimes is related to neglect.

Early treatment gives an abused or neglected child the best chance for recovery.

The first step is to provide a safe environment to prevent further harm. The sooner this happens, the better the child's chance for physical and emotional recovery. This includes separating the child, as well as any other children in the household, from the person suspected of abuse.

Any physical injuries will be treated, either in a hospital or at a doctor's office, depending on how serious they are.

Counseling is always recommended for abused or neglected children. It usually focuses on:

• How they feel about themselves.
• Their past experiences.
• Fears and concerns they may have about the present and future.

For very young children, counseling may involve play therapy.

• If you believe a child is in immediate danger, call 911 and get the child to a safe location. Arrange to stay in a safe place with the child.
• Look for signs of sexual or physical abuse. A child who has been abused may:
  • Be fearful and slow to trust.
  • Act out sexually in a manner that seems older than the child's years.
  • Wet the bed or have pain in the belly or genital area.
  • Have bruises, burns, or injuries that are not explained.
  • Be angry and aggressive or sullen and passive.
  • Be depressed.
  • Have trouble sleeping.
• Give love and support to a child who has been abused. If the child talks to you about the abuse, let the child know that talking about it is a very brave thing to do.