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Know

We all want to keep children safe. To do so, we must be able to recognize when a child is in harm’s way. Look for the following signs from the Child Welfare Information Gateway fact sheet on Child Abuse and Neglect (U.S. Department of Health and Human Services).

The child:

• Shows sudden changes in behavior or changes that seem like regression (e.g., losing skills they once had or crying more).
• Has not received help with physical or medical problems brought to the parent’s attention.
• Is always watchful, as though preparing for something bad to happen.
• Lacks adult supervision.
• Is overly compliant, passive, or withdrawn (e.g., doesn’t respond to situations that seem to warrant a response).
• Has little reaction to parents at pick-up or drop-off.

The parent:

• Shows little concern for the child.
• Denies the existence of—or blames the child for—the child's problems in the program or at home.
• Asks caregivers to use harsh physical discipline if the child misbehaves.
• Sees the child as entirely bad, worthless, or burdensome.
• Demands a level of physical or cognitive performance the child cannot achieve.
• Looks primarily to the child for care, attention, and satisfaction of emotional needs.

The parent and child:

• Rarely touch or look at each other.
• Do not respond to each other after a separation (i.e., at pick-up or drop-off).

It’s not always easy to recognize child abuse and neglect. Remember that any one of these signs by itself does not necessarily mean a child has been or is being abused or neglected. Often a pattern or combination of behaviors may lead to the suspicion that a child is experiencing abuse or neglect. Watch this video to learn about recognizing abuse and neglect.

Asking Questions and Opening the Lines of Communication

All toddlers get hurt occasionally: bumps, bruises, and scrapes can be signs of healthy exploration. Sometimes, more serious accidents happen as well, such as a child pulling a cup of hot tea down on themself or being involved in a car accident. Sometimes a medical condition causes symptoms that mimic abuse. For example, some skin conditions can leave marks that look like bruises or scars. To be most effective at protecting infants and toddlers from child abuse and neglect, we must be able to differentiate between accidents and abuse. Conversations are a powerful tool for doing so. Whenever you notice an injury or symptom in a child, complete an incident or accident report and ask about the injury. This is a standard part of caregiving and shows you take an interest in the child’s well-being. Remember, you are not investigating the injury. You are simply doing what comes naturally when someone is hurt: asking what happened and how the person is doing. Here are some tips for asking questions:

• Ask open-ended questions. You might say, “Ouch. That looks like it hurts. What happened?”
• Show concern and empathy: “I bet that was pretty scary for you guys. How did it happen?”
• Make sure it’s an okay time to talk and be prepared to get help if the family needs it. “Is it okay to ask you about Geri’s bruises? Do you have a minute?”
• Find out if there is anything else you should know about the injuries. “I’m glad you took her to the doctor. Is there anything we should do to make her comfortable during the day? Or is there anything she shouldn’t do?”

In most cases the family member will give you a clear and accurate account of what happened. For older toddlers, you can also ask the child what happened. You might suspect child abuse or neglect if:

• The child’s answer and the adult’s answers do not match or if two different adults give conflicting stories about how the injury happened. For example, a child has scratches all over her face. At drop-off, her dad says she got them from a child at a birthday party. At pick-up, her mom says she got them from the family cat.
• The story does not seem consistent with the child’s developmental level. For example, you might suspect abuse if a parent says a 4-month-old climbed out of a crib and got hurt.
• The story is not consistent with the injuries. For example, a child has burn marks on his hands that look almost like gloves—his hands were clearly submerged in something hot. His mother says the child accidentally grabbed a pot off the stove. Accidental burn injuries usually show a splatter pattern as the child pulls away.

Shaken Baby Syndrome

Shaken baby syndrome is a form of head trauma and brain injury. It can be caused by violently shaking, dropping, or throwing an infant. Most victims of shaken baby syndrome are under the age of 1, with the average age of victim being between 3 and 8 months, however it may be seen in children up to 5 years of age. When babies are shaken, their neck muscles are not strong enough to control their heads. This causes the brain to move back and forth inside the skull. The result is bleeding and bruising of the brain. The effects are even worse when the shaking ends with a sudden impact, such as when a child is slammed into a crib or against a wall. If you think the child has been shaken, seek medical attention right away.

Look for the following symptoms of shaken baby syndrome. Remember, no one sign alone is definitive evidence of abuse. Look for a combination of the following:

• altered consciousness
• an inability to focus the eyes or track movement
• an inability to lift the head
• decreased alertness
• difficulty breathing
• extreme irritability
• lack of smiling or vocalizing
• lethargy, sleepiness
• pale or bluish skin
• poor feeding
• problems sucking or swallowing
• rigidity
• seizures
• unequal pupil size
• vomiting

Resources You Should Know About

Your Training & Curriculum Specialist (T&CS) or Program Manager (PM) can be valuable resources as you learn about the signs of child abuse and neglect. They are your first line of support. Go to them whenever you have questions or concerns.

Your Family Advocacy Program (FAP) can provide training and technical support around recognizing child abuse and neglect. Talk to your T&CS, PM, and FAP representative about any questions or concerns you have.

The Family Advocacy Program will provide more installation- and Service-specific training on local issues, protocols, and resources. You will also receive additional training from your T&Cs throughout your career. This �Թ��� course is just the beginning of your professional learning around reporting and preventing child abuse and neglect.

You can find a quick summary of FAP roles and responsibilities as an attachment at the end of the Learn section.

See

The following are signs often associated with particular types of child abuse and neglect. However, note that these types of abuse are more typically found in combination than alone. A physically abused child, for example, is often emotionally abused as well, and a sexually abused child also may be neglected. Remember, there are two kinds of abuse to remain aware of: familial and institutional. The signs and behavioral indicators you see in children may be similar for each.

Recognizing Child Abuse and Neglect in Child Development Centers

Caring for children can be a stressful job. There can be a fine line between inappropriate caregiving practices and child abuse. When in doubt, talk to your administrator, T&CS, or FAP. Sometimes discipline practices cross the line into maltreatment and even abuse. You will learn more about that in the next course, as well as more about positive guidance. This course focuses on clear examples of child abuse or neglect in child development centers. If you see a pattern of any of these signs or behaviors, you might suspect child abuse or neglect in your setting.

Medical Conditions Mistaken for Abuse

There are several medical conditions that have symptoms that could be mistaken for abuse. It is important to be aware of these conditions, but remember you are not responsible for making medical diagnoses. If you have questions, ask the family or a community resource for support.

• Mongolian spots: These gray spots are present at birth and often look like bruises. They are usually found on the buttocks or lower back, but they can be found anywhere. They fade slowly over time.
• Blood or bleeding disorders: Some genetic conditions can cause severe bruising.
• Bone deficiencies or diseases: Some bone diseases cause bones to break easily.

Cultural Practices Mistaken for Abuse

Some cultures have rituals or healing practices that might be mistaken for signs of abuse. All suspected concerns of abuse should be immediately reported. It is not your job to determine whether something you see is a cultural practice or an instance of abuse. Even though the action may be a cultural practice, it could still be considered abuse. This is why you should make a report and let CPS or FAP make that determination. This section is intended only to give you some basic information about customs that can be mistaken for child abuse. Two common examples are coining and cupping.

In coining, the chest, back, and shoulders are rubbed with a medicated ointment. Then a warmed copper coin is rubbed from the top of the shoulders down the back. Dark lines appear from the pressure and the heat. The marks, which look like long bruises, usually last for several days.

Cupping is a home remedy used to relieve pain in the legs, back, chest, abdomen, or head. A small glass cup is held upside down and a candle is lit inside it. The cup is quickly placed on the skin and a vacuum effect draws the skin up. A circular mark is left on the skin for several days. Often there is a series of cup marks along the affected area. Olympic gold medalist and swimmer Michael Phelps brought the practice to the forefront during the 2016 Olympics.

There are many other cultural practices that might be considered child abuse by state law. If you are unsure whether a mark is a sign of child abuse, it is always best to make a report. The appropriate authorities will make the determination.

Do

• Get to know all the children in your care and their families. You cannot recognize a problem if you don’t know what is typical for the child. Learn children’s patterns, temperaments, preferences, and abilities. Talk to families every day.
• Learn all you can about child development. Some changes in a child’s behavior can be startling but completely typical. For example, it’s not unusual for toddlers to have bruises all over their legs or on their heads. Falling is a part of learning to walk and run! Young children may be scared of certain adults as part of typical “stranger anxiety.” Knowing these developmental stages can help you recognize when a child’s behavior goes beyond what is typically expected.
• Develop respectful communication skills. If you have a concern, ask about it. Ask open-ended questions that focus on the child’s well-being. “Is it okay if I ask you about Jordan’s bruises?” or “I’ve noticed that Tasha hasn’t seemed like herself lately. Is everything okay?” If something doesn’t seem right, gather as much information as you can.
• Keep careful records. Your daily health screening can be an important tool for identifying child abuse and neglect. Look for signs or behavioral indicators and write down what you see or hear. Write down adults’ explanations for injuries and children’s explanations (if applicable). If a pattern emerges, you will have ample evidence for making your report.
• Learn about the cultures of the children you serve. Some cultures have rituals or healing practices that might be mistaken for signs of abuse. Ask your trainer or manager for information if you need help. When in doubt, make a report. Child Protective Services or the Family Advocacy Program will decide whether abuse has occurred.
• Learn reporting procedures for your state or installation. You will learn more about this in the next lesson.