Chester River Hospital Center
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Identifying Child Abuse and Neglect


Robin Basque, RN

Child abuse and neglect are everyone’s problems. They happen in all kinds of families and in all cultures. All children are at risk. Abuse can be physical, sexual or emotional but the most common type is neglect. Neglect can be physical, emotional or educational. Abuse and neglect may occur individually or together. Each of us needs to be aware of this issue and to know when, how and to whom to report suspected cases of child abuse and neglect.

According to the National Child Abuse and Neglect Data System and the National Incidence Study of Child Abuse and Neglect, in 1997 there were more than three million reports of abuse and neglect; over one million of those were substantiated. For 1996, these agencies reported 1,185 child abuse and neglect deaths occurred.

How can you know if a child is being abused or neglected? First, you must understand what child abuse is and what the signs are that it is taking place. The evidence can be quite obvious or it can be very subtle; there will be characteristic behavioral and physical indicators to watch for depending on the type of abuse. Several types of abuse may occur at the same time such as physical and emotional abuse.

Physical child abuse is evidenced by physical injuries that are sustained as a result of biting, kicking, slapping, hitting, shoving, pushing, twisting, beating, shaking, burning, throwing, etc. These injuries may be intentional or accidental.

Sexual abuse may produce physical injury and a variety of emotional or behavioral responses. It includes, but is not limited to, touching or fondling a child’s genitals, having the child touch or fondle an adult’s genitals, intercourse, sodomy, exposure of the child to pornographic materials, photographing the child for pornographic purposes and child prostitution. The absence of physical injury in suspected cases of sexual abuse does not indicate the absence of sexual abuse. It is not uncommon to have no acute physical findings.

Emotional/psychological neglect is often difficult to identify or prove. Other forms of abuse cause emotional injury, but it is most commonly found in conjunction with physical and sexual abuse and neglect. Indicators may include failure to thrive, poor relationships with adults and/or peers, unusual fears, suicidal thoughts or gestures, hostility, aggression and being withdrawn or isolated.

Neglect is defined as failure to meet the minimal basic needs of a child like food, shelter, nurturing, medical care, emotional support, education and safety. Signs of neglect may include lack of medical care and of necessary medical devices like glasses, poor dental health, poor hygiene, being inappropriately dressed for the weather, developmental delays, poor relationships with adults and/or peers, aggressive or withdrawn behavior and having household responsibilities beyond what is normally expected for age and developmental levels.

Should you suspect a child is being abused or neglected report your concerns immediately. Do not wait to see if the signs get worse or stop. Maryland has a reporting requirement that states any individual who has reason to suspect child abuse or neglect must report the suspicion to the local department of social services or law enforcement agency. Act on your feeling and call Social Services in your county. Or call the police. You can make an anonymous phone call. You do not have to give your name. Let Social Services decide the validity of the concern. They are trained to decide if intervention is needed. You may be the only person who acts on the child’s behalf.

Robin Basque, RN, is the behavioral health specialist at Kent & Queen Anne’s Hospital. Her role is to coordinate services for patients who need specialized care either because of their mental health status or because they are the victims of substance abuse, sexual assault, child or elder abuse or domestic violence.