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Child Abuse and Neglect: An Overview

Child Abuse and Neglect: An Overview
Marilyn Massey-Stokes, EdD, CHES, CHWC
December 28, 2018
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Editor’s note: This text-based course is an edited transcript of the webinar, Child Abuse and Neglect: An Overview, presented by Marilyn Massey-Stokes, EdD.

Learning Outcomes

After this course, participants will be able to:

  • List the four main types of child abuse.
  • Describe risk and protective factors for child abuse.
  • Explain procedures for reporting suspected child abuse.
  • Describe child abuse prevention activities.

Introduction

 

Today I'm going to talk about a topic that's very near and dear to my heart, Child Abuse and Neglect. I've been interested in this topic for many years. Years ago, my husband worked as a licensed professional counselor and a licensed marriage and family therapist. He would come home and tell me stories about children and families that he was interacting with and it just wrenched my heart. I began to study about it and made a presentation on it and it's just never left me. Even though I've never worked as a counselor and worked one-on-one with these families, I still feel a pull in this direction, and I feel like that early childhood professionals have such a ripe opportunity to make a significant difference in these children's lives and in the lives of the families.

Selected Facts

  • For FFY 2016, CPS agencies received an estimated 4.1 million referrals for child abuse
  • 3.5 million children received CPS services
  • Highest rate of victimization occurred in children from birth to age one
  • 91.4% of child victims were maltreated by one or both parents
  • 70.0% of child victims were maltreated by a mother, either acting solo (40.3%) or with a father and/or other person (28.4%)
  • “Other” – male relative, male partner of parent, nonrelated adult, nonrelated child, foster sibling, household staff, babysitter, clergy, school personnel
  • An estimated 78% of child fatalities involved at least one parent
  • The three racial and ethnic groups most affected by child abuse are African American, Caucasian, and Hispanic

(USDHHS, 2018)

I'd like to begin by just sharing a few selected facts that may or may not surprise you about child abuse and neglect. The first bullet you'll notice says for FFY 2016, and I want to pause a moment and clarify that FFY stands for Federal Fiscal Year, and the Federal Fiscal Year in this case for 2016 spanned from October 1st, 2015, to September 30th, 2016. For FFY 2016, Child Protective Services, or CPS agencies, received an estimated 4.1 million referrals for child abuse. Let me pause again and clarify that term referral. A referral is basically an allegation. When CPS agencies receive referrals, they either screen them in for a response or screen them out. Keep in mind that CPS agencies receive far more referrals than what they actually screen in and follow up with a response. For this same Federal Fiscal Year 2016, 3.5 million children received CPS services. There again, you see 4.1 million referrals but 3.5 million actually received the services.

The highest rate of victimization occurred in children from birth to age one. In terms of this same Federal Fiscal Year of 2016, 91.4% of child victims were maltreated by one or both parents. This fact is hard to digest because we like to think it's someone other than the parent when in reality, the majority of these children are maltreated by one or both parents. 70% of child victims were maltreated by a mother, either acting solo or with a father and or another person. That other person could be a male relative, a male partner of the parent such as a boyfriend, a non-related adult, non-related child, foster sibling, household staff, babysitter, clergy, or school personnel.

An estimated 78% of child fatalities involved at least one parent. Here we're not talking just about maltreatment, but we're talking about deaths caused by child maltreatment. The three racial and ethnic groups most affected by child abuse are African American, Caucasian, and Hispanic.

What is Child Abuse and Neglect?

What do we mean by child abuse and neglect? Before I share the definition from the Federal Child Abuse Prevention and Treatment Act, I want to share with you a little tidbit, and that is that in the United States, animal rights were protected before children's rights. When I first heard this, I was absolutely stunned. I thought, how can that be, that we would protect animals before we would protect children? But unfortunately, that is the case in our country. If you'd like to read about this case which occurred in 1874, you can search the internet for Mary Ellen McCormack and read about it.

I located some information about it in The New York Times, and I just want to read a couple of direct quotes that come from an article. This is the little girl actually speaking. "Mama has been in the habit of whipping and beating me almost every day," the little girl testified. "She used to whip me with a twisted whip, a rawhide. I have now on my head two black and blue marks which were made by Mama with a whip, and a cut on the left side of my forehead which was made by a pair of scissors in Mama's hand. She struck me with the scissors and cut me. I never dared speak to anybody, because if I did, I would get whipped." These were words taken directly from this little girl back during when they were prosecuting the case. She actually was an orphan and this was her adoptive mother abusing her.

But ironically, the American Society for the Prevention of Cruelty to Animals was the organization who shed light on this case to begin with. I don't want to spend too much time on it, but I do want to let you know that this was the first case that actually brought to light that we do need to protect our children and we do need to prevent maltreatment. I also want to share that Mary Ellen did survive this. They removed her from the home and she did later get married at the young age of 24. She had two children and they also adopted a little orphan girl. According to this article, by all accounts, she was a very loving and caring mother. She died in 1956 at age 92. I also wanted to share that last portion with you because in spite of the cruel treatment that she had to endure and for a while, no one knew or cared, she was able to put together the pieces of her life and go on and get married and have children and be a loving, caring mother. I think that that gives hope in terms of those who do suffer abuse, that they can survive and they can go on to live full and productive lives.

Now I’d like to share the definition of child abuse and neglect that's taken directly from the Federal Child Abuse Prevention and Treatment Act (CAPTA) Reauthorization Act, 2010. This act has defined child abuse and neglect as at a minimum, "any recent act or failure to act on the part of the parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, or, Part B, an act or failure to act which presents an imminent risk of serious harm." That is a long definition, but if you want to come back to it later and kind of break it apart, it really does encapsulate the whole scope of child abuse and neglect.

Types of Child Abuse

You may have read about the different types of child abuse, and for the purpose of this presentation, I want to keep it with four main types. This is what you usually run across when you do some research about the topic. The four types are neglect, physical abuse, sexual abuse, and emotional abuse. I also want to mention that each state has its own definitions for child abuse. The foundation is captive, but I just want you to recognize that each state also has specific definitions in place so it's very important for you to be knowledgeable about your own state definitions as well as your state laws, and I'll come back to the state laws later in the presentation.

Chronic Child Neglect

Let's start with child neglect. Many places, you'll just read child neglect, but for the purposes of the definition that I'm sharing, it actually is called chronic child neglect. As Porchia-Usher defines, chronic child neglect is an ongoing, serious pattern of deprivation of a child's basic physical, developmental, and/or emotional needs for healthy growth and development. Child neglect is more prevalent and difficult to resolve than other forms of child abuse.

 

Prevalence of Child Neglect

Graph showing prevalence of child neglect versus other maltreatment

This graph shows the prevalence of the different forms of child maltreatment. You can see that neglect is far more prevalent than the other types of abuse. This information actually comes from the National Child Abuse and Neglect data system. They collected this data and used at least one report of maltreatment that was substantiated and reported by all 50 states, the District of Columbia, and Puerto Rico. This particular information is reported from October 1st, 2009 to September 30, 2010. It's a little bit dated but still accurate. You can see the category of other. The “other” category refers to threats of abandonment, threats of harm, or drug addiction.

Types of Neglect

Let's take a look at the types of neglect.

Physical Neglect. The failure to provide necessary food, clothing, and shelter; inappropriate or lack of supervision.

Medical Neglect. The failure to provide necessary medical or mental health treatment.

Educational Neglect. The failure to educate a child or to provide for special education needs.

Emotional Neglect. The failure to meet a child's emotional needs and provide psychosocial support, or permitting the child to use alcohol or other drugs.

I want to point out that this information comes from the Child Welfare Information Gateway, one of the best references you're going to run across. Much of the information in this presentation comes from this site.

Warning Signs of Neglect

In terms of the work you do as an early childhood professional, you need to be aware of the warning signs of neglect. Before I go over the warning signs, I want to mention, they are warning signs. It doesn't mean that if you see these signs, it's absolutely neglect and you must report it immediately. It just means that you need to pay attention. This isn't a complete list, but some of the more frequent signs that you may notice.

  • Lacks adequate medical or dental care
  • Often sleepy or hungry
  • Often dirty or inappropriately dressed for the weather
  • Home conditions are inadequate (e.g., unsanitary, unsafe, no place to sleep, exposure to alcohol or other drugs, etc.)
  • Lack of supervision or abandonment

(American Society for the Positive Care of Children, 2018; Child Welfare Information Gateway, 2013b)

The child lacks adequate medical or dental care. The child may seem sleepy or hungry, and not just occasionally, but repeatedly. The child may be often dirty or inappropriately dressed for the weather. The child may live in home conditions that are highly inadequate. It may be unsanitary, unsafe, no place to sleep, exposure to alcohol or other drugs, et cetera. There also may be a lack of supervision or abandonment.

As we pause here for a minute and look at these warning signs of neglect, I'd like for you to think about the children in your care, and whether you do have children in which you've noticed some of these signs. If so, you need to really pay attention and act in some way. I'll get into that in more detail in a moment.

I also want to mention something about children being dirty or inappropriately dressed for the weather. If you have a child who's repeatedly dirty or inappropriately dressed, it may be that the mother or the primary caregiver of the child is lacking some education or most likely, resources for that. It's very important to be able to determine whether it is a lack of resources and whether you need to connect that family to resources for help. There is a difference between having a lack of resources and not being able to provide and having resources or knowing where to get resources and refusing to provide. Sometimes those distinctions take some time to sort out.

In terms of the home conditions, I want to just share a very quick story. When I was at Texas Tech University in Lubbock, we were doing a child obesity study in a very poor zip code of Lubbock. We went in thinking that we were going to work on childhood obesity prevention, and our eyes were opened to a whole new world. It became abundantly clear that these children had far more issues to deal with than whether they were eating well or being physically active. Of course, these are very important issues, but what we saw was that their basic needs were not being met and it was a real eye-opener for me. We found out that some of these children didn't even have beds to sleep in. They were sleeping on the floor, and inside their homes, there was rampant substance abuse. Many times, there were a lot of alcohol bottles strewn about. They were really deplorable living conditions. That is one example of definite neglect.

Contributing Factors

Keep in mind that there are contributing factors to child neglect. Sometimes it's poverty and/or lack of education. In those cases, it may not be necessary for CPS to remove the child from the home. This is where your job as an early childhood professional is so incredibly important because you're the liaison to the family. You know the child, you know the family, and therefore, you're familiar with the circumstances. If you do perceive that there is some neglect but it is due to a lack of resources, please do your best to connect these families to local resources that can help them.

I just put a few examples here, but it could be that the caregiver or the parent actually needs some education. Locate some parenting education classes that you can connect these parents to. Depending upon your situation, if you're in a large childcare center, you may be actually offering the parenting education through your center. There should be family services and other social services within your community that you can connect families to. There may be food pantries or clothing outlets operated by churches or other places of worship.

I encourage you to stop and take some time to think about resources. If you're not familiar with the resources, this is a really good time to become familiar with them and maybe even keep a list at hand so that you're aware, and can easily point parents and other caregivers to those resources. With this said, if you don't believe that it's a lack of education or a lack of resources, and you feel like it is neglect that's purposeful and you need to make a report about it, then by all means, do that. If you're not sure, it's a good idea to get a colleague to observe and talk with a colleague about it and get feedback from that colleague. I'll get into the reporting a little bit later, but I just want you to be aware that sometimes it is purposeful neglect, and therefore needs to be acted upon.

Physical Abuse

Now we're going to move on to physical abuse. Physical abuse is defined as, "Non-accidental physical injury, (ranging from minor bruises to severe fractures or death) as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object) burning, or otherwise harming a child, that is inflicted by a parent, caregiver, or other person who has responsibility for the child." Physical abuse is the second most pervasive type of abuse. Again, as you recall, neglect is the number one most widespread type of abuse. (Child Welfare Information Gateway, 2013b, p. 3)

Warning Signs of Physical Abuse

  • Physical signs (bruises, cuts, burns, other unexplained marks on body)
  • Child is depressed, withdrawn, or apathetic
  • Child exhibits antisocial or destructive behavior
  • Child displays excessive fear

    (Child Welfare Information Gateway, 2013b)

There are various warning signs of abuse, and when we stop and think about it, of the four types of abuse, physical abuse is probably the easiest one to recognize because of the physical signs. You may see bruises, cuts, burns, or other unexplained marks on a child's body. As you know, just because a child has some marks on the body doesn't mean they're physically abused. Children are active, playful, and accidents do happen. What you need to be aware of are recurring marks on the body or marks that are unexplained. If a child is too young to be verbal, which may be the majority of the children in your care, you can and should ask the caregiver about it. What should be a warning sign is if the caregiver's reasoning for the marks doesn't align with the actual marks. I would encourage you to do some research about bruises. There are pictures online about bruises that are new as opposed to bruises that are several days old. That may help you uncover whether a story is accurate or not. You also want to look at the placement of the mark on the child's body. If that doesn't align with the story, that should be a warning signal to you.

I also want to mention that there are cultural practices that can sometimes leave marks on children's bodies that aren't necessarily abuse. One example I’d like to talk about is cupping. There are some cultures who practice this with different objects, and there are even healthcare providers who do cupping. It is sometimes called spooning as well because sometimes a spoon is the actual object that is used. It involves applying hard pressure to the skin, let's say the arm, to improve circulation. Some cultures believe it's a healing method. Again, there are various objects that are used. The reason I'm going into this is that it leaves ugly and disturbing marks on a child's body. I actually saw pictures of these from a professional who worked in the area of child abuse and neglect. She came to one of my classes at Texas Tech and showed a slideshow to my students. We all would have reported that as child abuse. She reminded us to be careful and be aware that cupping or spooning can take place.  There may be other terms used within families.

Keep in mind that warning signs of child abuse may not be physical signs but they could be emotional signs or behavioral signs. Some of the other signals that you can look for in the children in your care are children who appear to be depressed, they're very withdrawn, or they're very apathetic. It could be on the other end of the spectrum where the child exhibits very antisocial or destructive behavior. The child may display excessive fear, particularly when they're in the presence of a caregiver who's actually committing the abuse.

Factitious Disorder Imposed on Another (FDIA)

I'd like to share some additional information that falls under the umbrella of physical abuse. Factitious Disorder Imposed on Another, or FDIA was formerly known as Munchausen Syndrome by proxy. We had a recent case of this in the Dallas-Fort Worth area that really grabbed my attention. I know this is rare, but I still want to call your attention to it because it is frightening behavior, usually committed by the mother. FDIA is, as I mentioned, very rare, but it is a diagnosable mental illness that's characterized by a mother who acts as if her child is physically or psychologically ill when the child is really not ill. Generally, this is a young child, under the age of six. The mother is craving the attention and enjoys being in the spotlight for trying to care for this “ill” child because she wants people to think that she's such a caring and devoted mother. A mother with this disorder may create or exaggerate her child's symptoms in the following ways. She may flat out lie about the symptoms, or alter some type of diagnostic tests. If no one else is in the room, she can contaminate a urine sample, for example. She might doctor shop and find a doctor who will listen to her and treat her child in the way she thinks the child needs to be treated. She may even falsify medical records. Then sadly, she may induce the symptoms herself by either poisoning, suffocating, starving the child, or causing infection. (Cleveland Clinic, n.d.)

Warning Signs for FDIA

Some warning signs for FDIA are that the child has a history of multiple hospitalizations, there is a worsening of the child's symptoms reported by the mother yet not witnessed by hospital staff, or the child's condition improves in the hospital but symptoms recur once the child is back home. The blood in lab samples might not match the child's blood, or there might be signs of chemicals in the child's blood, stool, or urine.

If you are interested in reading about the case I mentioned it earlier that occurred in the Dallas-Fort Worth area, go to https://www.star-telegram.com/news/local/community/dallas/article188865169.html. It features an eight-year-old boy who was physically abused by his mother who had FDIA. He had numerous operations and was in hospice care at one point. I think it was the people in the hospice care who finally began to realize something was not right. This went on for years. I couldn't imagine how this could go on for years. The mother and father never were married. What’s unbelievable is the father went to court several times and tried to plead his case to a judge and say, something's not right, my child is not sick. He was asking for help, but the judge wouldn't believe him. The father spent a lot of time and money but finally withdrew because of his own emotional issues with it. He came back later and tried to fight again. Long story short, the father now has custody of the little boy and he appears to be doing just fine. What this mother subjected him to is absolutely deplorable. I hope you'll take a little time to read about this case because you never know. Even though they're rare, rarely does not mean impossible. If you happen to stumble across a case such as this that you just feel something isn't right, then I hope you'll remember this story and pursue it and save a child's life in the process.

Shaken Baby Syndrome (SBS)/Abusive Head Trauma (AHT)

As we wrap up the physical abuse portion, I want to talk about Shaken Baby Syndrome and Abusive Head Trauma. This topic is very difficult to talk about. I think most of us have a really hard time wrapping our minds around how someone could possibly hurt a defenseless baby in this fashion. Yet it occurs all the time, and I'm sure you've heard about it on the news or read about it in your local newspapers. It is the leading cause of U.S. child abuse deaths. It occurs most often in babies less than six months. There were approximately 1300 cases reported annually in the U.S., and the primary trigger is the perpetrator's frustration with the baby's crying. Approximately 25% of babies enduring this die. That's about a quarter of them. Approximately 80% of them suffer life-long disabilities. The lifetime average cost for SBS and AHT for the death is 7.2 million, and the total cost in 2010 was estimated at 13.5 billion. The bottom line is, yes, these economic costs are absolutely staggering, but more importantly, the human pain and suffering are absolutely immeasurable. (National Center on Shaken Baby Syndrome, 2018)

What is SBS/AHT?

Here is the definition, taken from the National Center on Shaken Baby Syndrome. Shaken baby syndrome and abusive head trauma is a term used to describe the constellation of signs and symptoms resulting from violent shaking and impacting of the head of an infant or small child. The American Academy of Pediatrics (AAP) describes SBS as a subset of AHT, with injuries having the potential to result in death or permanent neurologic disability. (National Center on Shaken Baby Syndrome, 2018, para. 1)

Consequences of SBS/AHT

  • Learning disabilities
  • Physical disabilities
  • Visual disabilities or blindness
  • Hearing impairment
  • Speech disabilities
  • Cerebral Palsy
  • Seizures
  • Behavior disorders
  • Cognitive impairment
  • Death

(National Center on Shaken Baby Syndrome, 2018)

You can see the whole list of consequences of shaken baby syndrome and acute head trauma spanning from learning disabilities to all sorts of physical disabilities, behavior disorders, cognitive impairment, which is oftentimes very severe, and death.

Vulnerability of Babies

Most of you understand the vulnerability of babies, but just a quick review. Their heads are very heavy and large in proportion to their body size, their neck muscles are extremely weak, their brains are very fragile and undeveloped, and there is a very large size and strength difference between the victim and the perpetrator. I will never forget one day that my husband came home from working at an advocacy center and sat down in the floor and put his head in his hands. I said, honey, what's wrong? He said, I just had to look at autopsy photos of a baby who was basically slung across the room and slammed into a wall. It was a very shaking experience for him. I know that's a graphic story, but it just accentuates the horrific nature of this type of abuse.

What About Other Activities?

Some people want to know about other activities, and so I want to quickly share with you a little information. The National Center on Shaken Baby Syndrome does say that activities that may cause shaking are not recommended, but the following activities are likely not to cause shaken baby syndrome injuries.

  • Bouncing a baby on your knee
  • Tossing a baby in the air
  • Jogging or bicycling with your baby
  • Falls off a couch or other furniture
  • Sudden stops in a car or driving over bumps

(National Center on Shaken Baby Syndrome, 2018)

I'm still not really crazy about tossing a baby in the air, but just be aware that any type of bouncing or shaking is definitely not recommended.

Signs of SBS/AHT

Here are some signs that you need to be familiar with:

  • Decreased level of consciousness
  • Seizures
  • Head or forehead appears larger than usual
  • Soft spot on head appears to be bulging
  • Inability to lift head
  • Inability of eyes to focus or track movement
  • Unequal size of pupils

(National Center on Shaken Baby Syndrome, 2018)

The Period of PURPLE Crying

I also want to mention a free resource that I hope you will check out and share with parents. It's called the Period of PURPLE Crying. It is an evidence-based or research-based prevention program that's backed by years of solid research. The two aims of the program are to support parents and caregivers in understanding early increased infant crying and to decrease the incidence of shaken baby syndrome and acute head trauma. So please check out purplecrying.info. This is a website for parents, and there's also The Period of PURPLE Crying app that I hope you will share with your parents as well and suggest that they download onto their smartphones.

Emotional (or Psychological) Abuse

Emotional or psychological abuse is the third type of abuse I want to cover, and this type of behavior severely impairs a child's emotional development or their sense of self-worth. Some examples are constant criticism, belittling, threats, rejection, or withholding love, support, or guidance. One of the most important things I want to point out is that emotional abuse underlies all the other forms of abuse. Even though it may not seem as pervasive as the others, if you think about the fact that it does underlie the other forms of abuse, it's just as pervasive as the other forms. It's very difficult to prove because there are no outward signs. (Child Welfare Information Gateway, 2013b)

Warning Signs of Emotional Abuse

Here are some warning signs of emotional abuse:

  • Behavioral extremes – e.g., overly compliant or demanding; aggressive or passive and withdrawn
  • Delayed emotional development
  • Emotion regulation difficulties
  • Lack of attachment to parent/other caregiver

     (Child Welfare Information Gateway, 2013b)

You may see some behavioral extremes, from being overly compliant or demanding, aggressive, or passively withdrawn. There may be delayed emotional development, emotion regulation difficulties, which again, may span the spectrum, either very regressive behaviors or aggressive and behavioral problems. There also may be a lack of attachment to the parent or other caregiver.

Attachment

As you know, attachment is so critical in the early years. Bowlby defined attachment as that lasting psychological connectedness between human beings. (McLeod, 2009) Attachment is vital for healthy child development and their adaptability, safety, stress management, resilience, and their overall wellbeing. (Child Welfare Information Gateway, 2013b; Rees, 2007)

Attachment Problems

Emotional abuse and any kind of abuse will disrupt healthy attachment. You could have disorganized attachment, which means there is no coherent or consistent behavior during separation from and reunion with their parents. (American Psychological Association, 2018a)

This means, in one instance it may be very upsetting for the child, in another instance, it's like nothing has ever happened. It's very inconsistent and disorganized. Or there could be a very insecure attachment. This is generally a negative parent-child relationship in which the child is not confident when the parent is present, may display distress when the parent leaves, and then may react to the returning parent by avoidance. (American Psychological Association, 2018b)

Sexual Abuse

CAPTA (2010) defined sexual abuse as: “the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children.” Child Welfare Information Gateway (2013b, p. 4)

Be aware that sexual abuse does include any type of sexual behavior or sexually explicit conduct as well as sexual exploitation of children.

Signs of Sexual Abuse

Signs of sexual abuse in infants can be a failure to thrive or blood in the diapers or unexplained bruises. In toddlers and older children, it could be unexplained bruises, regressive behaviors such as thumb sucking and bed wetting when they've already passed that developmental stage, nightmares, or very tense or nervous interactions with adults. (Child Mind Institute, 2018)

Warning Signs – Adult

The warning signs in adults are that they can be secretive and isolated, they can be very jealous or controlling with family members, overly protective of the child, and severely limiting the child's contact with other children, particularly those of the opposite sex. (Child Welfare Information Gateway, 2013b)

Consequences of Child Abuse and Neglect

As you know, the consequences of child abuse and neglect are very far-reaching. They can be physical, psychological, behavioral, and societal.

  • Physical. AHT, impaired development, physical health problems, death
  • Psychological. Emotional and cognitive delays, poor mental and emotional health, attachment problems, social difficulties
  • Behavioral. Difficulties during adolescence, juvenile delinquency and adult criminality, alcohol and other drug abuse, abusive behavior and other acts of violence
  • Societal. Direct costs ($$$); indirect costs: health care system, social services, juvenile and adult criminal activity, mental illness, substance abuse, domestic violence, human suffering and low quality of life

   (Child Welfare Information Gateway, 2013a)

Factors Impacting the Consequences of Child Abuse and Neglect

I also want to mention that there are many factors impacting the consequences of child abuse and neglect. The child's age and developmental status at the time of the maltreatment makes a huge difference in the consequences. In addition, the type of maltreatment, the frequency, duration, and severity of the abuse, as well as the relationship between the child and the perpetrator impact the consequences of child abuse and neglect. (Child Welfare Information Gateway, 2013a, 2013b)

Risk Factors

There are many risk factors that increase the likelihood of abuse. There could be a cycle of abuse, meaning the parent was abused and it's just repeating that cycle. There could be inadequate parenting skills, a lack of coping skills and emotional regulation on the part of the parent or caregiver, and then very frequently, there is alcohol and other drug abuse. Other risk factors are mental illness, domestic violence, criminal behavior, dysfunctional family unit, a lack of support that the parent in the family has, and then, those children with special needs are at greater risk for abuse.

Protective Factors

Protective factors are those factors that mitigate the risk. This is where I really want you to think about how you can instill more protective factors in the lives of the children and their families in which you serve. Protective factors can come at multiple levels. They can come within the individual, as intrapersonal, they can be interpersonal, with family and other caregivers, they can be in the broader community, within policy, that is laws, or in the overall society.

I want to encourage you in your work as an early childhood professional that you do play such a crucial role in the lives of children and families. You have the opportunity to bond and connect with the child in meaningful ways and to promote overall health and safety of the child. Please be alert to the warning signs. You know your families and are their liaison, their champion, and their referral source. You're also a mandated reporter of suspected child maltreatment.

Reporting Suspected Child Abuse and Neglect

Caring for Our Children, 3rd ed. (CFOC3) recognizes the importance of caregivers receiving ongoing training regarding recognizing and preventing child abuse and neglect and the reporting of it. Parents and guardians should be notified of the child care facility’s child abuse and neglect reporting requirements and procedures, whether it's a home-based facility or a larger facility.

If you suspect a child is being abused or neglected, you are mandated by law to report it. This is not your supervisor, this is you. I would encourage you to be familiar with the laws in your state because they do vary across the states. I also recommend that you take notes about things you see. This would include the date, time, and what you observed. You may be required to produce evidence which could be your notes or pictures. If you suspect a child is in immediate danger, call 911. If you're not sure, consult with a colleague, get a second opinion. By all means, don't ignore it. If your gut feeling tells you something is wrong, there is likely something wrong, so rely on your intuition and your professional judgment. For more information, go to Child Welfare Information Gateway. You can get information specific to your state. Another excellent resource is the Childhelp National Child Abuse Hotline, and you can call that at any time. 1-800-4-A-CHILD (800.422.4453) (National Resource Center for Health and Safety in Child Care and Early Education, 2018)

Prevention Activities

I'd like to start bringing the presentation to a close by mentioning prevention.

Primary prevention

Primary prevention is the universal prevention aimed at stopping child maltreatment from ever occurring. (Child Welfare Information Gateway, n.d.-a) Some examples of these are parent education classes, raising awareness through social media, newsletters, health fairs, and activities that you can conduct during Child Abuse Prevention Month (April), or even donating your time and money to child abuse prevention organizations. Take a look at these activities because I believe that you play such a vital role in primary prevention. See what you can do with Child Abuse Prevention Month. Go online and get materials. Go to your social media and raise awareness. (Child Welfare Information Gateway, n.d.-a)

Secondary prevention 

Secondary prevention focuses on families at risk for child maltreatment, so possible problems may have already been noted. Some examples of where you can connect parents with resources include parenting education, especially for teen parents. Families or parents may need to be connected to substance abuse treatment programs, support groups, or family resource centers. Also important is respite care for those families that have children with special needs so they can get the help and support that is necessary to nurture and care for that child. I'm not going into tertiary prevention, because that level of prevention is focused on when child abuse and neglect have already been proven and that's out of the scope of this presentation. (Child Welfare Information Gateway, n.d.-a)

What Can You Do?

What can you do as an early childhood professional, as a person? Children have a right to be loved, nurtured, and safe. Pay close attention to the children in your world. Be alert to signs that something isn't right. Trust your instincts and act.

Take Action!

What can you do to ensure the safety and well-being of the children in your care? I would like for you to write down one to three steps you can take to play an active role in the prevention of child abuse and neglect. I encourage you to stop the presentation right now, write it down on a notecard, sticky note, or whatever works for you. Put it in your smartphone if that works. Share the steps with a coworker or other childcare professional. Those people can act as accountability partners. If you're working in a larger center and someone else has watched this presentation or you want to share this with one of your coworkers or a neighbor, friend, or family member, do so, and then share the information with each other.

But more importantly, take action. #TakeAction I borrowed another hashtag from Prevent Child Abuse America, and that's, ALL CHILDREN DESERVE #GREATCHILDHOODS (Prevent Child Abuse America, 2018). I'd like to end with a very brief lesson from the sea that I received permission from Jack Pransky to share with you. Jack Pransky is a prevention professional. He's written several books and actually conducts prevention trainings. I'm taking this lesson from the sea from his book called Prevention: The Critical Need. If you like what you hear and you want to get more information about what Jack does, you can go to jackpransky.com.

A lesson from the sea. One day as I was walking along a beach by the sea, becoming lost in the salt air and pounding surf, I looked down just in time to avoid slicing my foot on the jagged glass of a broken bottle. Cautiously, I stepped around it and proceeded by the ocean. I spotted a shining jewel in the wet sand, left behind by the tide. I moved closer. It was a beautiful, smooth, frosty piece of sea glass. Here was a lesson. Who are the young people who caused so many problems? Like jagged pieces of broken glass, they lash out at the world around them or at themselves. Can these same children also be beautiful sea glass, lovable to all, appreciated, cherished, and respected? Something happens within the ocean turbulence that changes the jaggedness into smoothness, into something to be appreciated. The only difference between the two pieces of glass is the environment itself. Our behavior appears to be shaped by conditions in our environment, particularly as we grow. This is an essential piece to the puzzle. The way our children are treated within their important environments appears to largely determine the shape they will be in and how they will be.

I want you to look at the children in your life, your own children, the children you work with on a daily basis, and view them as these jewels. Protect these little jewels and do your best to ensure that they grow up loved and nurtured, so that they have the opportunity to reach their full potential and be the best they can be.

References

American Psychological Association. (2018a). APA dictionary of psychology – disorganized attachment. Retrieved from https://dictionary.apa.org/disorganized-attachment

American Psychological Association. (2018b). APA dictionary of psychology – insecure attachment. https://dictionary.apa.org/insecure-attachment

American Society for the Positive Care of Children. (2018). Child neglect. Retrieved from https://americanspcc.org/neglect/

Childhelp. (n.d.). The Childhelp national child abuse hotline. Retrieved from https://www.childhelp.org/hotline/

Child Mind Institute. (2018). Signs of sexual abuse in children and adolescents. Retrieved from https://childmind.org/article/signs-of-sexual-abuse-in-children-and-adolescents/

Child Welfare Information Gateway. (n.d.-a). Framework for prevention of child maltreatment. Retrieved from https://www.childwelfare.gov/topics/preventing/overview/framework/#one

Child Welfare Information Gateway. (n.d.-b). Responding to child abuse & neglect. Retrieved from https://www.childwelfare.gov/topics/responding/

Child Welfare Information Gateway. (2013a). Long-term consequences of child abuse and neglect. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. Retrieved from https://www.childwelfare.gov/pubPDFs/long_term_consequences.pdf#page=3&view=Factors Affecting the Consequences of Child Abuse and Neglect

Child Welfare Information Gateway. (2013b). What is child abuse and neglect? Recognizing the signs and symptoms. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. Retrieved from https://www.childwelfare.gov/pubPDFs/whatiscan.pdf

Cleveland Clinic (n.d.) Factitious disorder imposed on another (FDIA). Retrieved from https://my.clevelandclinic.org/health/diseases/9834-factitious-disorder-imposed-on-another-fdia

      McLeod, S. A. (2009). Attachment theory. Retrieved from www.simplypsychology.org/attachment.html

      National Center on Shaken Baby Syndrome. (n.d.-a). Retrieved from https://www.dontshake.org

National Center on Shaken Baby Syndrome. (n.d.-b). What is the Period of PURPLE Crying program? Retrieved from https://www.dontshake.org/purple-crying

National Center on Shaken Baby Syndrome. (2018.). Learn more. Retrieved from https://www.dontshake.org/learn-more#2016

National Resource Center for Health and Safety in Child Care and Early Education. (2018). Caring for our children (3rd ed. [CFOC3]), 3.4.4, Child abuse and neglect. Retrieved from http://nrckids.org/CFOC/Database/3.4.4.1

Porchia-Usher, D. Chronic neglect (white paper). DC Child and Family Services Agency. Retrieved from https://cfsa.dc.gov/sites/default/files/dc/sites/cfsa/publication/attachments/Chronic_Neglect_Paper.pdf

      Pransky, J. (1991). Prevention: The critical need. Springfield, MO, US: Burrell Foundation; Greenbrae, CA, US: Paradigm Press.

      Prevent Child Abuse America. (2018). Retrieved from http://preventchildabuse.org/

Rees, C. (2007). Childhood attachment. British Journal of General Practice, 57(544), 920–922. doi:10.3399/096016407782317955

U.S. Department of Health and Human Services. (n.d.). What is child abuse or neglect? What is the definition of child abuse and neglect? Retrieved from https://www.hhs.gov/answers/programs-for-families-and-children/what-is-child-abuse/index.html

U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2018). Child maltreatment 2016. Retrieved from https://www.acf.hhs.gov/cb/research-data-technology/statistics-research/child-maltreatment

Citation

Massey-Stokes, M. (2018). Child Abuse and Neglect: An Overview. continued.com – Early Childhood Education, Article 23081. Retrieved from www.continued.com/early-childhood-education


marilyn massey stokes

Marilyn Massey-Stokes, EdD, CHES, CHWC

Dr. Massey-Stokes is Associate Professor and Associate Director of Undergraduate Academic Programs in the School of Health Promotion and Kinesiology at Texas Woman's University. She has approximately 30 years of experience teaching health at the university level and has actively engaged in scholarship related to health education and health promotion, including child and adolescent health. Dr. Massey-Stokes is also a Certified Health Education Specialist and Certified Health and Wellness Coach. Her passion is promoting health and wellness across the lifespan, and she particularly enjoys working with adult learners.



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