Child Abuse: Recognizing the Signs and Knowing How to Help the Innocent

By Lynn Carson, Ph.D.

Would you recognize if a child was being abused or neglected? What if you saw bruises or suspected malnutrition, knew the child was wetting the bed, displaying unsuitable behaviors, or using language that isn’t age-appropriate? In other words, if you had a gnawing bad feeling that wouldn’t go away about the well-being of a minor, would you know what to say or do?

Independently, these situations do not always indicate abuse; however, all can be considered a form of child abuse, and when more than one of these are present, red flags should be raised. That’s why it’s important to know the signs so you can help the innocent by knowing where report it.

According to the Pennsylvania Child Protection Services Law, child abuse and neglect include serious and intentional physical or mental injury, sexual abuse or exploitation, serious neglect, imminent (immediate) risk of serious physical injury, or imminent risk of sexual abuse or exploitation of children under the age of 18, caused by the act of a perpetrator or failure to act.

While it’s sometimes a gray area in knowing whether or not a child is suffering harm, there is little dispute in the fact that children rarely are victimized by a stranger. In fact about 90% of victims know their abuser. They can be a relative, family friend, coach, neighbor, teacher, or daycare provider.

Anyone with access to children has the potential to take advantage of them. And the numbers are startling. In Pennsylvania, more than 24,000 reports of suspected abuse or neglect of a child are made each year. Unfortunately, that number is likely higher as these are only the cases reported. Often, people are hesitant to get involved for fear of being wrong or causing more problems, but experts believe it’s better to speak up and err on the side of caution. It could save a child’s life. There are five categories of abuse. They may or may not occur in conjunction with one another. By definition, these forms include:

• Physical abuse. Physical child abuse occurs when a child is purposely physically injured or put at risk of harm by another person.
• Sexual abuse. Any sexual activity with a child is considered sexual abuse and may include fondling, oral-genital contact, intercourse, exploitation, or exposure to child pornography.
• Emotional abuse. Emotional child abuse means injuring a child's self-esteem or emotional well-being. It includes verbal and emotional assault — such as continually belittling or berating a child — as well as isolating, ignoring, or rejecting a child.
• Medical abuse. Medical child abuse occurs when someone gives false information about illness in a child that requires medical attention, putting the child at risk of injury and unnecessary medical care.
• Neglect. Child neglect is failure to provide adequate food, shelter, affection, supervision, education, or dental or medical care.

SIGNS TO WATCH

Children who are abused in any form are not only scared, but also may be consumed by guilt, shame, and confusion. Depending upon the child’s age, he or she may understand right from wrong, but still blame themselves or think they need to fix the situation or abuser – especially if the abuser is a parent or individual on whom the child is dependent.

As a result, children don’t always tell someone what is happening. If an abuser threatens the child, silence is almost guaranteed. There are red flags, however, that can suggest something is wrong. If you recognize any of the following in a child – whether suddenly or gradually – it may be time to talk to the child and report what you know to a person of authority.

• Withdrawal from friends or usual activities
• Changes in behavior — such as aggression, anger, hostility, or hyperactivity — or changes in school performance
• Depression, anxiety or unusual fears, or a sudden loss of self-confidence
• An apparent lack of supervision
• Frequent absences from school
• Reluctance to leave school activities, as if he or she doesn't want to go home
• Attempts at running away
• Rebellious or defiant behavior
• Self-harm or attempts at suicide

WHAT IS MY RESPONSIBILITY?

Remember, in many cases, abuse is at the hands of someone the child knows and trusts. If you are someone the adolescent trusts and he or she begins to reveal details that elude to abuse, it is your obligation to report it to the proper authorities. It’s the role of County Children and Youth Agency caseworkers and law enforcement offices to make the decisions – based upon their investigations, make decisions about whether there is sufficient evidence to indicate a child is being abused or neglected. The bottom line is if you are suspicious or know anything, say something.

For those who interact with children as their job (teacher, religious instructor, daycare provider, teacher, health care provider, coach, etc.), you are considered a “mandated reporter,” and you required to report any suspected child abuse.

While kids often maintain silence, abusers may exhibit signs that raise red flags, which also requires action. They include:

• Lack of respect or concern for the child
• Unable or unwilling to recognize physical or emotional distress in the child
• Blames the child for the problems
• Demeans and ridicules the child to the extent of embarrassment and shame
• Regularly criticizes or “puts down” the child using negative terms like "worthless" or "evil"
• Expects the child to provide him or her with attention and care and seems jealous of other family members getting attention from the child
• Uses harsh physical discipline, including spanking
• Has unrealistic expectations of the child by demanding an inappropriate level of physical or academic performance
• Severely limits the child's contact with others
• Offers conflicting or unconvincing explanations for a child's injuries or no explanation at all – and may blame the child for lying and wanting attention

WHAT DO I SAY?

Finding the right words or any words when abuse is suspected or a child shares upsetting information is difficult to say the least. The most important thing to do is LISTEN, answer any questions, and provide comfort and support. Remind the child you always are willing to listen, because initially they may not be ready to tell you the entire story or remember all the details.

Some helpful phrases to begin the conversation or sustain communication may include:

• Use age-appropriate language
• Remain calm and remind them they are safe
• Remind them they are not in trouble
• Consider these phrases for affirmation and reassurance:
  • “I love you.”
  • “I believe you.”
  • “I feel sad/angry this happened to you.”
  • “I will work to keep you safe and take care of you.”
  • “It’s not your fault.”
  • “I’m glad you told me and trusted me to share.”
  • “You’re very brave.”

WHO TO CALL FOR HELP

While you may be tempted to approach the abuser, it’s advised you do not contact that individual. If the child needs immediate medical attention, call 9-1-1 or your local emergency number. Depending on the situation, contact the child's doctor or health care provider, a local child protective agency, the police department, or a 24-hour hotline such as Childhelp National Child Abuse Hotline (1-800-422-4453).

At the UPMC Pinnacle Children’s Resource Center (CRC), our work is focused on reducing the occurrence and aftermath of child abuse by improving the health, welfare, and safety of children and families in central Pennsylvania. The CRC offers a child-friendly, central location for child-protective services, law enforcement, district attorneys, victim’s services, and mental health agencies to work in tandem in order to protect the child.

Following a visit to the CRC, information may still surface and it’s important to contact your caseworker and/or law enforcement immediately.

What is a Child Advocacy Center?

Child advocacy centers (CACs) are neutral, child-friendly, multidisciplinary services for children and families affected by sexual abuse or severe physical abuse. CACs bring together, in one location, child protective services investigators, law enforcement, prosecutors, and medical and mental health professionals to provide a coordinated, comprehensive response to victims and their caregivers.  The goal is to take all of these services and offer them in one place to minimize the length of the investigation and reduce potential trauma to the child.

UPMC Children’s Resource Center (CRC) offers children and families affected by allegations of sexual and physical abuse medical services, forensic interviews and mental health services. 

In 2019 the CRC received 1307 referrals to see children who had allegations of sexual or serious physical abuse as well as witness and rule out interviews.  The CRC primarily serves Dauphin, Cumberland, Lebanon and Perry counties, but has seen children from all over the United States. 

Why use a CAC?

• Research shows that children are less likely to talk about their abusive experiences with someone in authority. 
• Children need a safe environment away from the alleged offender and where the abuse may have occurred.
• Forensic interviewers within the CAC have training in a legally defensible child interviewing protocol and issues of child development.

If you notice different behaviors or patterns consistently, please reach out to a mental health professional or start with your family doctor or a health care provider. Remember, child abuse is preventable — and often a symptom of a problem that may be treatable. Help is available.

April is Child Abuse Awareness Month, but thousands of children suffer abuse every day of the year, so it’s important to be vigilant and proactive when abuse is suspected or known. Pinwheels for Prevention® is a national campaign that raises awareness of child abuse and the ways in which we can help prevent it. To participate and learn more about the ways in which they are helping those in need, visit us online at UPMCPinnacle.com/Pinwheels.

While children can overcome abuse and lead healthy, happy lives, many suffer the physical, emotional, behavioral and emotional ramifications years later. For more information about child abuse, child advocacy, and where to go if you suspect a child needs help, call the CRC at 717-782-6800 to speak with someone.