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Child Abuse

Author: Julia Tortorice

 

Child Abuse | Copyright © 2013 CEUFast.com


 

Purpose/Goals

The purpose of this course is to assist healthcare professionals in identifying and responding to child abuse.

 

Objectives

After completing this course, the learner will be able to meet the following six objectives:

1. Identify physical and behavioral indicators associated with child abuse and maltreatment/neglect
   
2. discuss the impact of abuse on children,
   
3. identify resources for reporting child abuse, and
   
4. discuss the healthcare professional’s role in identification and prevention of child abuse.

Violence is an important public health issue. The World Health Organization (WHO) estimates that nearly 53,000 children are murdered each year, and that the prevalence of forced sexual intercourse and other forms of sexual violence involving touch, among boys and girls under 18, is 73 million and 150 million respectively (WHO, 2013).

In the US, for 2011, an estimated 1,545 children died from abuse and neglect. The national fatality rate per 100,000 children in the population was 2.10 for 2011, the same as it was for 2010. The number of reported child fatalities due to child abuse and neglect has fluctuated during the past 5 years, from 1,608 in 2007 to a high of 1,685 in 2009, and a low of 1,545 in 2011(DHHS, 2011, pg. 56).

Children younger than 1 year had the highest rate of victimization at 21.2 per 1,000 children in the population of the same age. In general, the rate and percentage of victimization decreased with age. Victimization was split between the sexes, with boys accounting for 48.6 percent and girls accounting for 51.1 percent. Eighty-seven percent of (unique count) victims were comprised of three races or ethnicities— African-American (21.5%), Hispanic (22.1%), and White (43.9%). However, victims of African-American, American Indian or Alaska Native, and multiple racial descent had the highest rates per 1,000 children in the population of the same race or ethnicity, of victimization at 14.3, 11.4, and 10.1 victims, respectively. Analyzing 5 years of race and ethnicity data reveals that 78.5% of (unique count) victims were neglected, 17.6% were physically abused, and 9.1% were sexually abused. Because a victim may have suffered from more than one type of maltreatment, every maltreatment type was counted, which is why the percentages total to more than 100. (DHHS, 2011, pg. 17).

Studies conclude that professionals that have contact with children report only half of the incidents that may be abuse or maltreatment/neglect (Research foundation, 2011). The reason for this low report rate was confusion or misunderstanding about the laws and procedures and a lack of knowledge or awareness of warning signs. The study also found the professionals are often influenced by their professional beliefs values and past experiences (Research foundation, 2011).

Each State provides its own definitions of child abuse and neglect within the civil and criminal context. Civil laws, or statutes, describe the circumstances and conditions that obligate mandated reporters to report known or suspected cases of abuse. They also provide definitions necessary for juvenile/family courts to take custody of a child alleged to have been maltreated. Criminal statutes define the forms of maltreatment that are criminally punishable (NCANDS, 2011). All states require healthcare personnel, school personnel, daycare providers and law enforcement personnel to report child abuse. Failure to do so is a crime.

Child abuse and neglect is, at a minimum:

  Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation.
   
  An act or failure to act that presents an imminent risk of serious harm.

 

Indicators

Indicators of abuse warn the healthcare professional to pay more attention to a particular situation. Sometimes there are no indicators even though the child is being abused. There are three types of indicators of abuse or maltreatment/neglect; 1) physical indicators, 2) child behavioral indicators, and 3) parent behavioral indicators.
Indicators should not be viewed in isolation they must be considered in relationship to the child’s condition. Indicators should be considered in the overall context of the child’s physical appearance and behavior. Sometimes a single indicator is self-evident or points to abuse or maltreatment/neglect. Often several indicators must be pulled together or clusters of indicators used to develop reasonable cause (Research foundation, 2011).

Some healthcare professionals see a child only once are very infrequently others see them more often. In looking for reasonable cause you need to consider what you know about the child’s normal behavior. No two children will respond the same way to the same situation.

Physical Indicators

Common physical indicators are severe unexplained or suspicious bruises and welts, fractures, burns, lacerations, or abrasions. Specific physical indicators are (Research foundation, 2011, participant’s guide pg. 6):

1.  unexplained bruises and welts
   
a. On face, lips, mouth, torso, back, buttocks or thighs.
   
 


(AbuseWatch.net, 2012)
 

 


Bruising of torso, buttocks
and thighs (AbuseWatch.net, 2012)

b. Bruises in various stages of healing clustered bruises forming regular patterns that might reflect the shape of an article used to inflict the injury
   
c. bruises on several different areas
   
d. bruises regularly appear after absence, weekend, or vacation
   
2. unexplained fractures
   
a. to nose, skull, or facial structure
   
b. in various stages of healing
   
c. multiple or Spiral fractures
   
 


Spiral Fracture (AbuseWatch.net, 2012)
 

d. swollen or tender lambs
   
3.  unexplained burns
   
a. cigar, cigarette burns especially on the soles of feet, palms, back and buttocks
   
 


Cigarette burn (AbuseWatch.net, 2012)
 

b. immersion burns: sock like, glove like, doughnut shaped on buttocks or genitalia
   
 


Glove like burn (AbuseWatch.net, 2012)
 

 


Sock like burn (AbuseWatch.net, 2012)
 

b. immersion burns: sock like, glove like, doughnut shaped on buttocks or genitalia
   
c. patterned like electric burner or iron
   
 


(AbuseWatch.net, 2012)
 

d. rope burns on arms, legs, neck, or torso
   
 


Looped cord injury
(AbuseWatch.net, 2012)
 

4.  unexplained lacerations or abrasions
   
a. to mouth, lips, gums, or eyes
   
b. to external genitalia
   
c. on back of arms, legs, or torso
   
d. human bite marks
   
e. frequent injuries that are accidental or unexplained

Accidental injuries usually involve injury on a bony prominence of the body such as elbows and knees and shins. Suspicious injuries usually occur in areas not susceptible to accidental age-appropriate areas. The following pictures indicate areas where children would normally bruises, and suspicious bruising areas, as well as other suspicious areas of injury.

 


(AbuseWatch.net, 2012)
 

 

 


Clues to the mechanism of injury:
(AbuseWatch.net, 2012)
 

 


(AbuseWatch.net, 2012)
 

Consider the size and shape of the injury, as well as the location of injury (Research foundation, 2011). Consider the relationship of the mechanism of injury (explanation of how injury occurred) to the child’s developmental stage. For example toddlers fall when they learn to walk and young children scrape their knees when learning to ride a bicycle. Consider if the story that was given as an explanation for an injury would produce the physical indicators that are present. For instance a toddler falls to the floor while walking, not striking anything when he fell. That toddler has bruises on the back of his legs. One would expect that from a fall, while walking, the toddler would have bruises and scrapes on his hands, knees, and shins; not bruises on the back of his legs.

Child behavioral indicators of physical abuse may be (Research foundation, 2011, participant’s guide pg. 6):

1. the child is wary of adult contact,
   
2. apprehensive when other children cry,
   
3. demonstrates behavioral extremes,
   
4. frightened of parents,
   
5. afraid to go home,
   
6. reports injury by parent,
   
7. wears long sleeve or similar clothing to hide injuries,
   
8. Seeks affection from adults.

Parent behavioral indicators of physical abuse may be (Research foundation, 2011, participant’s guide pg. 6):

1. seemed unconcerned about the child
   
2. takes an usual amount of time to obtain medical care for the child
   
3. offers inadequate or inappropriate explanations for the injury
   
4. gives different explanations for the same injury
   
5. misuses drugs or alcohol
   
6. disciplines the child to harshly considering the child’s age or what she has done wrong
   
7. sees the child as bad or evil
   
8. has a history of abuse as a child
   
9. attempts to conceal the child’s injury
   
10. takes a child to a different hospital or doctor for each injury
   
11. has poor impulse control

Maltreatment/Neglect

Child physical indicators of maltreatment/neglect may be (Research foundation, 2011, participant’s guide pg. 7):

1. consistent hunger, poor hygiene, inappropriate dress
   
2. consistent lack of supervision, especially in dangerous activities or for long periods
   
3. unattended physical problems or medical or dental needs
   
4. abandonment
   

Child behavioral indicators of maltreatment/neglect may be (Research foundation, 2011, participant’s guide pg. 7):

1. begging or stealing food
   
2. extended stays in school – arrives early, leaves late
   
3. attendance at school infrequent
   
4. consistent fatigue, falls asleep in class
   
5. alcohol and drug abuse
   
6. states there is no caretaker
   

Parental behavior indicators of maltreatment/neglect may be (Research foundation, 2011, participant’s guide pg. 7):

1. misuses alcohol or other drugs
   
2. has disorganized, upsetting home life
   
3. is apathetic, feeling nothing will change
   
4. is isolated from friends, relatives, neighbors
   
5. has long term chronic illness
   
6. cannot be found
   
7. has history of neglect as a child
   
8. exposes child to unsafe living conditions
   
9. evidences limited intellectual capacity
   

Emotional Maltreatment

Child physical indicators of emotional maltreatment may be (Research foundation, 2011, participant’s guide pg. 7):

1. Conduct disorders such as fighting in school, antisocial, or destructive.
   
2. Habit disorders such as rocking, fighting, or sucking fingers
   
3. neurotic disorders such as speech disorders, sleep problems, or inhibition of play
   
4. psychoneurotic reactions such as phobias, hysterical reactions, compulsions, or hypochondria
   
5. lags in physical development
   
6. failure to thrive
   
 


(AbuseWatch.net, 2012)
 

Child behavioral indicators of emotional maltreatment may be (Research foundation, 2011, participant’s guide pg. 7):

1. overly adaptive behavior such as inappropriately adult or inappropriately infantile
   
2. developmental delays, mental or emotional
   
3. extremes of behavior such as compliant, passive, aggressive, or demanding
   
4. suicide attempt or gestures or self-mutilation
   

Parent behavioral indicators of emotional maltreatment may be (Research foundation, 2011, participant’s guide pg. 7):

1. treats children in the family unequally
   
2. doesn’t seem to care much about child’s problem
   
3. blames or belittles child
   
4. is cold and rejecting
   
5. inconsistent behavior toward child

Sexual Abuse

Child physical indicators of sexual abuse may be (Research foundation, 2011, participant’s guide pg. 8):

1. difficulty in walking or sitting
   
2. Torn, sustained, or bloody underclothing,
   
3. Pain or itching in genitalia.
   
4. Pregnancy, especially in early adolescence
   
5. bruises or bleeding in external genitalia, vaginal or anal areas
   
6. sexually transmitted diseases especially in pre-adolescent age group, includes venereal oral infections
   

Child behavioral indicators of sexual abuse may be (Research foundation, 2011, participant’s guide pg. 8):

1. unwilling to change for or participate in physical education class
   
2. withdrawal, fantasy, or infantile behavior
   
3. bizarre, sophisticated, unusual sexual behavior or knowledge
   
4. self-injurious behaviors, suicide attempts
   
5. poor peer relationships
   
6. aggressive or disruptive behavior, delinquency, running away, or school truancy
   
7. reports sexual assault by caretakers
   
8. exaggerated fear of closeness or physical contact
   

Parent behavioral indicators of sexual abuse may be (Research foundation, 2011, participant’s guide pg. 8):

1. very protective or jealous of child
   
2. encourages child to engage in prostitution or sexual acts in the presence of caretaker
   
3. misuses alcohol or drugs
   
4. is geographically isolated and/or lacking in social and emotional contacts outside the family
   
5. has low self-esteem

Shaken Baby Syndrome

When a baby is vigorously shaken, the head moves back and forth. A baby’s head and neck are susceptible to head trauma because the muscles are not fully developed and the brain tissue is exceptionally fragile. Shaken Baby Syndrome occurs most frequently in infants younger than six months old, but it can occur up to age three (National Shaken Baby, 2008). The sudden whiplash motion causes the injury to the baby. That motion can cause bleeding inside the head and increased pressure on the brain, causing the brain to pull apart. Often, there are no obvious outward signs. Shaken Baby Syndrome is one of the leading forms of fatal child abuse. Head trauma, is the leading cause of disability due to abuse of infants (National Shaken Baby, 2008). Shaken baby syndrome is often misdiagnosed and under diagnosed (Hopper, 2012).

Munchausen’s Syndrome by Proxy

Munchausen’s syndrome by proxy (MSBP) is when a parent commits physical abuse while trying to intentionally fabricating illnesses in their children. The existing research is based on a small number of cases and needs to be expanded. However, the research suggests that victims of MSBP experience significant psychological and psychiatric symptomatology in both childhood and adulthood. Most cases of MSBP are believed go undetected, so the actual incidence of this type of abuse is unknown. Because of the sometimes extreme abuse inflicted by parents with MSBP (e.g., broken bones, poisoning), their children are at great risk for serious physical and psychiatric morbidity (Kaplan, 1999).

 

Factors Influencing Child Abuse

The incidence of child maltreatment varies as a function of family income, family structure, family size, and the metropolitan status of the county. As circumstances deteriorate, maltreatment becomes more prevalent and more severe (Sedlak, 1996).

Child characteristics (NCANDS, 2008):

  The highest victimization rates were for the 0-3 age group, 13.9 per 1,000
   
  Victimization rates by race/ethnicity ranged from 4.4 per 1,000 for Asian/Pacific Islander to 25.2 per 1,000 for African-American victims
   
  43% % of the fatalities were younger than 1 year of age, and 86% were younger than 6 years of age
   
  38% of the fatalities were associated with neglect
   
  Girls were sexually abused more often than boys
   
  Boys had a greater risk of serious injury and emotional neglect than girls
   
  Children are vulnerable to sexual abuse from age three on
   
  Older children have greater opportunities for escape, and are more able to defend themselves and/or retaliate
   
  Pre-maturity, difficult temperament and mentally handicapped children have been associated with parents that are less responsive and less attentive to their needs (National Clearinghouse, 2003)
   
  Physical abuse peaks in the 4-8 year old age range. Psychological abuse peaks in the 6-8 year old range and remains at a similar level through adolescence (Kaplan, 1999)

Unless otherwise noted, the statistics noted below are taken from Child Maltreatment 2006 and refer to the Federal fiscal year (FY) 2006 (U.S. Department of Health and Human Services, 2008).

 

 


(Child Maltreatment 2006 and refer to the Federal fiscal year (FY) 2006
(U.S. Department of Health and Human Services, 2008).

 

Research indicates that young children, ages 3 and younger, are the most frequent victims of child fatalities. NCANDS data for 2006 demonstrated that children younger than 1 year accounted for 44.2 % of fatalities, while children younger than 4 years accounted for more than three-quarters (78.0 %) of fatalities. These children are the most vulnerable for many reasons, including their small size, dependency, and inability to defend themselves. Fatal child abuse may be due to acute or chronic abuse. Repeated abuse over a period of time (e.g., battered child syndrome) is a chronic situation and an acute abuse may involve a single, impulsive incident (e.g., drowning, suffocating, or shaking a baby). In cases of fatal neglect, the child’s death results from a caregiver’s failure to act. The neglect may be chronic (e.g., extended malnourishment) or acute (e.g., an infant or child who drowns after being left unsupervised in the bathtub).

In 2006, 41.1% of child maltreatment fatalities were associated with neglect alone. Physical abuse alone was cited in almost one-quarter (22.4%) of reported fatalities. Another 31.4% of fatalities were the result of multiple maltreatment types. In 2006, one or both parents were responsible for 75.9% of child abuse or neglect fatalities. 14.7% of fatalities were the result of maltreatment by non-parent caretakers, and the remaining 9.5% represents unknown or missing information.

Family characteristics (Sedlak, 1996)

  Children of single parents have a 77% greater risk of being harmed by physical abuse; an 87% greater risk of being harmed by physical neglect; and an 80% greater risk of suffering serious injury or harm from abuse or neglect.
   
  Children in the largest families were physically neglected at nearly three times the rate of those who came from single-child families.
   
  Children from families with annual incomes below $15,000 as compared to children from families with annual incomes above $30,000 per year were over 22 times more likely to experience some form of maltreatment.
   
  Children from the lowest income families were 18 times more likely to be sexually abused, almost 56 times more likely to be educationally neglected, and over 22 times more likely to be seriously injured from maltreatment.
   
  The estimated rate of neglect among families with four or more children was almost double the rate among families with three or fewer children (National Clearinghouse, 2003).

Abuser Characteristics

The ability to provide adequate care for a child depends partly on the parent’s emotional maturity, coping skills, knowledge about children, mental capacity, and parenting skills. Alcohol or drug abuse is often present in cases of child neglect (National Clearinghouse, 2003).

NCANDS (2008) found the following conclusions about perpetrators, when the perpetrator was known:

  62% of perpetrators were female.
   
  87% of all victims were maltreated by at least one parent.
   
  The most common pattern of was a child victimized by a female parent acting alone.
   
  Neglect and physical abuse were more frequently perpetrated by a female parent.
   
  Sexual abuse was more frequently perpetrated by a male parent.

The following are five characteristics of neglectful mothers (National Clearinghouse, 2008):

  Impulse-ridden
   
  Apathetic
   
  Suffering from reactive depression
   
  Mentally retarded
   
  Psychotic

High-risk parents may be identified using the following indicators (National Clearinghouse, 2008):

  Poverty
   
  Mental retardation
   
  Drug abuse
   
  Lack of social support
   
  History of being maltreated
   
  Observing parent¬ and infant interactions for indicators of poor bonding
   
  Standard risk assessment instruments.

 

Impact of Abuse on Children

Physical abuse or neglect is associated with a large number of interpersonal, cognitive, emotional, behavioral, and substance abuse problems. There is also an associated increase in psychiatric disorders and increased mental health services utilization. There is an association between physical abuse and the risk for suicidal behavior, particularly in adolescents. Aggressive and delinquent behaviors are frequently correlated with physical abuse (Kaplan, 1999).

Psychological maltreatment may have a stronger relationship to long-term psychological functioning than other forms of maltreatment. Psychological abuse is a stronger predictor than physical maltreatment of a wide array of problems, including internalizing and externalizing behaviors, social impairment, low self-esteem, suicidal behavior, as well as current and previous psychiatric diagnoses and hospitalizations.

A history of physical abuse increased a subject’s odds of attempting suicide by almost 5 times, while a history of psychological abuse increased the odds of a suicide attempt by more than 12 times. Perceived emotional rejection by parents has been associated with poor adolescent and young adult outcomes in substance abuse and delinquency (Kaplan, 1999), (Lazenbatt, 2010).

Physical abuse can result in various types of injuries, especially if the abuse occurs within the first three years of life (Lazenbatt, 2010).

  The physical consequences of ‘shaken baby syndrome’ can range from vomiting or irritability to more severe effects, such as concussions, respiratory distress, seizures, and death... Two-thirds of subdural hemorrhages in children under two are caused by physical abuse... It is estimated that 10 per cent of admissions to pediatric burns and plastic surgery units are related to child maltreatment (Lazenbatt, 2010, pg. 5).

Infants who are neglected and malnourished may have non-organic failure to thrive (Lazenbatt, 2010).

Domestic abuse poses a serious risk even to the unborn fetus. The risks are

  premature birth
   
  low birth weight
   
  chorioamnionitis
   
  fetal injury
   
  death

Fetal morbidity resulting from violence may be more prevalent than that from gestational diabetes or pre-eclampsia. Fetal abuse can have effects on the developing infant’s brain, leading to childhood anxiety and hyperactivity (Lazenbatt, 2010).

Neglect may inhibit the development of regions of that brain hampering the child’s functioning (Lazenbatt, 2010). Abused children may have impaired cognitive abilities, poor academic achievement and deficits in both receptive and expressive language. Abused adolescents report deficits in the social functioning, like impaired styles of interpersonal attachment, engaging in more aggression in their peer relationships, and exhibiting more abusive or coercive behaviors in dating relationships. Abuse victims are at increased risk for a variety of child and adolescent psychiatric diagnoses, including depressive disorders, anxiety disorders, conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder and substance abuse (Kaplan, 1999).

Abuse can have indirect health affects. Physical and sexual abuse is a major factor in the homelessness of young people, which may result in risk-taking behaviors including substance abuse, self-harming, prostitution, and increased vulnerability to further assault. Child victims of sexual abuse may be more prone to sexually transmitted infections (Lazenbatt, 2010).

“The broad range of direct and indirect health effects of child maltreatment is likely to have a substantial impact on a victim’s life expectancy and long-term health-related quality of life” (Lazenbatt, 2010, pg. 7).
 

 

Talking with Children

The role of the healthcare professionals to assess for reasonable cause to suspect maltreatment/neglect or abuse. The healthcare professional is not to investigate or interrogate. The healthcare professional identifies reasonable cause and leaves the investigation and interrogation to specially trained workers in child protective services or law enforcement.

When talking with children to establish reasonable cause to suspect abuse or maltreatment/neglect, find a private place and remain calm. Be honest, opening, and up front with the child. Be supportive. Listen to the child and stress that it’s not the child’s fault. Do not overreact, make judgments, make promises, nor interrogate or investigate.

 

What Is Reasonable Cause to Suspect Abuse or Maltreatment

Reasonable cause to suspect things that based on what you have observed or been told, combined with your training and experience, you feel that harm or imminent danger of harm to the child could be the result of an act or omission by the person legally responsible for the child. If there is reasonable cause to suspect the child is being abused or maltreated (Research foundation, 2011, Trainer’s Presentation Guide, pg. 26).

Crimes committed against the child should be reported directly to law enforcement. If the child is in imminent danger, contact law enforcement immediately. Imminent danger is when the child is placed at immediate risk or a substantial risk of harm (Research foundation, 2011).

 

Case Studies
   
A. A female, age 15, has comes to the ER with the rash on her vaginal area. She discloses she has been engaging in sexual intercourse with her mother’s 38-year-old boyfriend for the past two months. The boyfriend has resided in the house with the child and her mother for the past five years and is responsible for the care of the child when the mother is at work (Research foundation, 2011, Participant Guide, Medical pg. 15).
   
What indicators are present?
Is there a reasonable cost to suspect abuse or maltreatment?
 
  What are your next steps?
   
B. Seven-year-old Chris came to the doctor’s office for a physical. He has a bruise on the right side of his face with scrapes along his right arm. The child claimed he fell off his bike. The child lives with his mother, a single parent. She says Chris is a very active child and at times can present challenging behaviors at school (Research foundation, 2011, Participant Guide, Medical pg. 16).
   
What indicators are present?
   
  Is there a reasonable cost to suspect abuse or maltreatment?
   
  What are your next steps?
   
C. A mother delivers a baby that has neonatal drug withdrawal. When talking to the mother, you learned she has not prepared for baby to come home (Research foundation, 2011, Participant Guide, Medical pg. 17).
   
  What indicators are present?
   
  Is there a reasonable cost to suspect abuse or maltreatment?
   
  What are your next steps?
   
D. Eight-year-old Jason comes to the ER with a broken arm. His mother says he fell off the bed. When Jason Jason’s arm is x-rayed there’s a spiral fracture to his humorous (Research foundation, 2011, Participant Guide, Medical pg. 18).
   
What indicators are present?
   
  Is there a reasonable cost to suspect abuse or maltreatment?
   
  What are your next steps?
   

Case Study Answers

Case Study A

  What indicators are present? Sexual abuse and verbal disclosure
   
  Is there reasonable cause to suspect abuse or maltreatment? Yes
   
  What are your next steps? Report abuse, maltreatment, or neglect

Case Study B

  What indicators are present? Bruises, scrapes
   
  Is there reasonable cause to suspect abuse or maltreatment? No, the story is consistent with a bike injury. Injuries sustained in an accidental fall would be along one side of the child’s body.
   
  What are your next steps? Treat child’s injury.

Case Study C

  What indicators are present? Neonatal drug withdrawal and no plan for the baby
   
  Is there reasonable cause to suspect abuse or maltreatment? Yes
   
  What are your next steps? Report abuse, maltreatment, or neglect

Case Study D

  What indicators are present? Spiral fracture, explanation is not plausible
   
  Is there reasonable cause to suspect abuse or maltreatment? Yes
   
  What are your next steps? Report abuse, maltreatment, or neglect

 

Summary

Child fatalities due to abuse and neglect are a serious problem in the United States. Fatalities disproportionately affect young children and most often are caused by one or both of the child’s parents. Child fatality review teams have been created to accurately count, respond to, and prevent child abuse and neglect fatalities, as well as other preventable deaths.

Prevention is one way of helping to prevent abuse, neglect and untimely deaths from occurring. The child fatality review process helps identify risk factors that may assist prevention professionals. These prevention teams are demonstrating effectiveness in translating review findings into action by partnering with child welfare and other child health and safety groups. In some States, review team annual reports have led to State legislation, policy changes, or prevention programs (National Center for Child Death Review, 2007).

In 2003, the Office on Child Abuse and Neglect, within the Children’s Bureau, Administration for Children and Families, U.S. Department of Health and Human Services, launched a Child Abuse Prevention Initiative to raise awareness of the issue in a much more visible and comprehensive way than ever before. Today, “The Prevention Initiative” is an opportunity to work together in communities across the country to support parents and promote safe children and healthy families. Increasingly, this effort focuses on promoting protective factors that enhance the capacity of parents, caregivers, and communities to protect, nurture, and promote the healthy development of children. Healthcare professionals working in emergency rooms and clinics need to take the initiative to report child abuse findings to the proper authorities in a timely manner before deaths occur to our nation’s innocents.

 

Child Abuse Reporting Contact Information

Reporting Numbers Resource List is from Child Welfare Information Gateway (2013). Information Updated on February 28, 2013.

State toll-free numbers for specific agencies designated to receive and investigate reports

Alabama
Local (toll): (334) 242-9500
Visit Website
Click on the website above for information on reporting or call Childhelp® (800-422-4453) for assistance.

Alaska
Toll-Free: (800) 478-4444
Visit Website

Arizona
Toll-Free: (888) SOS-CHILD (888-767-2445)
Visit Website
California
Visit Website
Click on the website above for information on reporting or call Childhelp® (800-422-4453) for assistance.
Arkansas
Toll-Free: (800) 482-5964
Visit Website
Colorado
Local (toll): (303) 866-5932
Visit Website
Click on the website above for information on reporting or call (303) 866.5932

Major Program(s)/Initiatives(s):
 
  Heart Gallery
Connecticut
TDD: (800) 624-5518
Toll-Free: (800) 842-2288
Visit Website
Delaware
Toll-Free: (800) 292-9582
Visit Website
District of Columbia
Local (toll): (202) 671-SAFE (202-671-7233)
Visit Website
Florida
Toll-Free: (800) 96-ABUSE (800-962-2873)
Visit Website
Georgia
Visit Website
Click on the website above for information on reporting or call Childhelp® (800-422-4453) for assistance.
Hawaii
Local (toll): (808) 832-5300
Visit Website
Idaho
TDD: (208) 332-7205
Toll-Free: (800) 926-2588
Visit Website
Illinois
Toll-Free: (800) 252-2873
Local (toll): (217) 524-2606
Visit Website
Indiana
Toll-Free: (800) 800-5556
Visit Website
Iowa
Toll-Free: (800) 362-2178
Visit Website
Kansas
Toll-Free: (800) 922-5330
Visit Website
Kentucky
Toll-Free: (877) 597-2331
Visit Website
Louisiana
Toll-Free: (855) 452-5437
Visit Website
Maine
TTY: (800) 963-9490
Toll-Free: (800) 452-1999
Visit Website
Maryland
Visit Website
Click on the website above for information on reporting or call Childhelp® (800-422-4453) for assistance.
Massachusetts
Toll-Free: (800) 792-5200
Visit Website
Michigan
Fax: (616) 977-1154
(616) 977-1158
Toll-Free: (855) 444-3911
Visit Website
Minnesota
Visit Website
Click on the website above for information on reporting or call Childhelp® (800-422-4453) for assistance.
Mississippi
Toll-Free: (800) 222-8000
Local (toll): (601) 359-4991
Visit Website
Missouri
Toll-Free: (800) 392-3738
Visit Website
Montana
Toll-Free: (866) 820-5437
Visit Website
Nebraska
Toll-Free: (800) 652-1999
Visit Website
Nevada
Toll-Free: (800) 992-5757
Visit Website
New Hampshire
Toll-Free: (800) 894-5533
Local (toll): (603) 271-6556
Visit Website
New Jersey
TDD: (800) 835-5510
TTY: (800) 835-5510
Toll-Free: (877) 652-2873
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New Mexico
Toll-Free: (855) 333-7233
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New York
TDD: (800) 369-2437
Toll-Free: (800) 342-3720
Local (toll): (518) 474-8740
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North Carolina
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North Dakota
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Ohio
Toll-Free: (855) 642-4453
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Oklahoma
Toll-Free: (800) 522-3511
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Oregon
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Pennsylvania
TDD: (866) 872-1677
Toll-Free: (800) 932-0313
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Puerto Rico
Toll-Free: (800) 981-8333
Local (toll): (787) 749-1333
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Rhode Island
Toll-Free: (800) RI-CHILD (800-742-4453)
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South Carolina
Local (toll): (803) 898-7318
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South Dakota
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Tennessee
Toll-Free: (877) 237-0004
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Texas
Department of Family and Protective Services
Toll-Free: (800) 252-5400
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Utah
Toll-Free: (855) 323-3237
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Vermont
After hours: (800) 649-5285
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Virginia
Toll-Free: (800) 552-7096
Local (toll): (804) 786-8536
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Washington
TTY: (800) 624-6186
Toll-Free: (800) 562-5624
(866) END-HARM (866-363-4276)
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West Virginia
Toll-Free: (800) 352-6513
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Wisconsin
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Wyoming
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References

AbuseWatch.net (2012) Prevention Resources for the Community and Professionals Retrieved May 5, 2013

American Academy of Child & Adolescent Psychiatry (2011). Child Sexual Avuse. N. 9. March 2011. Retrieved 2/28/13

Child Protective Services. (2010). 2010 Monitoring and Analysis Profiles With Selected Trend Data: 2006 – 2010 (2010) New York State. Retrieved on 4/30/13

Child Welfare Information Gateway Resource (2013). Updated 2/28/2013. Retrieved on 2/28/13

Hopper, J. (2012) Child Abuse: Statistics, Research and Resources. Manisses, 2/1/2012. Retrieved 2/28/13

Kaplan, S., (1999). Adolescent Abuse and Neglect Research: A Review of the Past 10 Years. Part I: Physical and Emotional Abuse and Neglect. Journal of the American Academy of Child and Adolescent Psychiatry. 10/1999.

Lazenbatt, A. (2010). Research Briefing: The impact of abuse and neglect on the health and mental health of childrenand young people. Retrieved November 21, 2013.

Lahoti, S. (2001). Evaluating the Child for Sexual Abuse, American Family Physician, 03/1/2001.

National Children’s Advocacy Center. (2008). Retrieved on 09/2008

National Clearinghouse on Child Abuse and Neglect (2008). Information at www.calib.com/nccanch, Retrieved on 09/2008.

National Shaken Baby Syndrome Campaign. (2008). Babies are fragile. Please don’t shake a child. National Exchange Club Foundation, www.preventchildabuse.com, retrieved on 09/2008.

Nudelman, J., et al. (1999). Building Bridges Between Domestic Violence Advocates and Health Care Providers. National Resource Center on Domestic Violence www.vaw.umn.edu/library/dv/. Retrieved on 09/2008.

Research foundation for SUNY (2011). Mandated reporter trainer’s resource guide; identifying and reporting child abuse and maltreatment/neglect. Buffalo State College, Center for development of human services, 2011.

Sedlak, A., et.al. (1996). Executive Summary of the Third National Incidence Study of Child Abuse and Neglect. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families and National Center on Child Abuse and Neglect. Westat, Inc

U.S. Department of Health & Human Services (2008) Recognizing Child Abuse and Neglect: Signs and Symptoms: Retrieved on 09/2008.

U.S. Department of Health & Human Services (2012). Child Maltreatment 2011. Retrieved 2/28/13

U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, 2011. Child Maltreatment 2011, retrieved May 1, 2013

World Health Organization, 2013. Prevention of Child Maltreatment, retrieved May 31, 2013