Child maltreatment prevention, recognition and response-reporting: How to spot child abuse for physicians

Child maltreatment prevention, recognition and response-reporting: How to spot child abuse for physicians

By Vinod B. Rao, M.D.

Child maltreatment is a significant concern in society today. The primary goal should always be to prevent child maltreatment; however, when abuse does occur it is important for everyone to know how to recognize signs and how to respond. The following will discuss strategies for how you can help with prevention, recognition and response for child maltreatment.

Prevention

For sexual abuse, it is important to educate children about proper names to call their “private parts” (genitals, buttocks, breast). It is also critical to teach them that these areas are private and 1) it is not OK for other people to have the child see or touch those areas on the other person; 2) nor is it appropriate for other people to ask to see or touch those areas on the child. A child should be taught that this includes anyone — and not just strangers; however, teaching about danger from strangers is also important.

For physical abuse, it is important for caregivers to have appropriate understanding of what their child’s developmental capabilities are as they grow. Additionally, it is recommended to avoid physical punishment. The use of physical punishment poses an increased risk of causing physical injury. Additionally, physical punishment has been identified to have risks including increased prevalence of mental health problems, negative relationships with parents, increased aggression and increased risk of subsequent physical abuse of the child. The alternative age-appropriate methods of discipline can include: timeouts of one minute per year of age, redirection, setting clear limits, offering limited choices, giving clear directions, taking away privileges, teaching alternatives and praising/rewarding good behaviors.

Verbal children also need to understand that if there are concerns, they should tell a trusted adult, and it is OK for them to tell.

Recognition

For physical abuse, it is important to know that bruising on the torso, ears, or neck of a child under 4 years old, or bruising anywhere on a child under 4 months old, should raise concern and prompt further exploration and reporting.

For sexual abuse, often the most important indication is what the child reports as having occurred. Child sexual abuse can include but is not limited to: contact for sexual purposes, molestation, statutory rape, prostitution/human trafficking, exposure/observation of sexual content or sexual behaviors of others, pornography, or incest, as well as other forms of sexual exploitation. Children who have been sexually abused can present with varying degrees of signs and symptoms; however, absence of these should not discount what a child reports as having occurred.

Signs and symptoms may include:

  • Daytime wetting accidents after previously being able to stay dry
  • Nighttime bed wetting after previously being able to stay dry
  • Soiling (stool) accidents after previously achieved continence
  • Depression
  • Anxiety
  • Fear
  • Sleep disturbance
  • Appetite changes
  • Self-esteem problems
  • Interpersonal relationship problems
  • Regression of development
  • Sexualized behavior
  • Change in school behavior
  • Blood in urine
  • Burning with urination
  • Unexplained genital bruising or oral bruising
  • Sexually transmitted disease
  • Pain, bleeding, discharge or lesions of the vagina, penis, anus or mouth

Any of these justifies a conversation with the child’s medical provider, as sexual abuse is only one of the possible causes of some of these findings.

Response

It is important for all members of the public to remember that in Kentucky, everyone is mandated by law to report suspected child maltreatment by caregivers when there is reasonable cause to suspect that it is occurring. This includes child physical abuse, sexual abuse, neglect or any other concern of maltreatment by a caregiver.

To make a report in Kentucky, call the Kentucky Child Protection Hotline toll-free 24/7 at (877) KYSAFE1 (597-2331). In Indiana, call the Indiana Child Abuse and Neglect Hotline toll-free 24/7 at (800) 800-5556. It is also appropriate to report these concerns to police.

Additionally, when a child makes statements to an adult that raise these concerns, it can often be very difficult for that adult to hear; it even may cause a sense of shock or dismay in the adult. However, it is important to maintain a calm demeanor and provide supportive statements without asking excessive questions. For example, the adult can say: “I’m glad you told me about this today.” In addition to reporting the abuse to the authorities, it is vital to seek medical attention when appropriate, and if unsure whether medical attention is needed, to call and speak with the child’s medical provider for guidance.

 

Vinod B. Rao, M.D. specializes in Child Abuse Pediatrics and is an assistant professor with the University of Louisville School of Medicine Department of Pediatrics. He is also a member of the Norton Children’s Hospital Child Abuse Taskforce.