Working with the Child Protective Services, Childrens Aid Society,
Family and Childrens Services whichever it is in your neighborhood, I have learned
the many ways children can get abused. We learned the signs and signals to
recognize and deal with the symptoms. In Canada, as in many other Countries
around the world, we have a law " Duty to Report that a child is in need of
Protection". The Act clearly states, that each and every person has the
responsibility to alert Child Welfare Authorities to a child they believe is
abused or in some way not adequately cared for.
The informant can remain anonymous.
That any person who performs official and professional duties with children
(i.e. teachers, doctors, day care workers,clergy, recreation workers, etc.)
MUST REPORT PROMPTLY to F.A.C.S. any situation where they think a
child may be in need of protection.

Their professional duty overrides confidentiality in relationships between
professionals and service user / client.

Their failure to report child abuse is liable, on conviction, to a fine of up to
$1,000.00. And in some places up to six months imprisonment.

I have worked with abused children for almost 30 years, seen firsthand
what they had to endure, and help them overcome all forms of abuse.



Forms of abuse:




Physical Abuse: nonaccidental trauma (bruises, fractures, head and abdominal injuries) usually by the care taker.

Sexual Abuse: engaging of dependent, developmentally immature children in sexual activities,� photography, voyeurism or oral genital including rape and incest.

Emotional Abuse: rejection, ignoring, criticizing or terrorizing of children in such a way to erode their self image.� Most commonly verbal abuse.

Physical Neglect: failure to provide necessities of food, shelter, clothing and a safe environment beyond the realm of lack of financial resources.

Emotional Neglect: inability to recognize and respond to a child�s needs commonly resulting in Failure to Thrive with a lack of normal parent-child attachment.

Medical Neglect: failure to provide needed medical attention to a child

Munchausen Syndrome by Proxy: a caretaker, usually the mother, creates or simulates an illness in a child which places the child at risk of unneeded surgeries, medical therapies, etc.� Rare!

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Recognition

How does someone recognize abuse/neglect?� You must first think about it.� If you don�t think about it, you will never recognize it.� It must be done in a nonaccusatory and compassionate manner.
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Physical Abuse: The explanation, if any, does not correlate with the injury e.g. a spiral fracture of the thigh from simply falling off the bed or a changing description� of events.� There is often a delay in seeking medical attention.� There may be a frequent changing of doctors or hospitals by the caretaker.� The caretaker may exhibit stress and or unrealistic expectations of the child.� Often, the caretaker will have been abused as a child.� Patterned bruises e.g. belt marks, looped electrical cords etc. may lead to suspicion.� Unusual burns, dental trauma, etc.� Bruises in toddlers and children, typically, are over bony prominences like shins, knees, elbows etc., not over the stomach.� Infants unable to walk should not have bruises.� Lacerations to the frenulum and or bruising of the lips are often related to forced feeding of an infant.� Burns of a stocking-glove pattern should raise suspicion i.e. punishing an child for wetting his pants by placing him in a tub of scalding water will reveal a clear line where the water went up to and his bottom will not be burnt where it touched the tub.� This is often described as �donut hole� sparing.� Any accidental spill should have splash marks.� Small � inch circular scabs should raise the question about cigarette burns especially on the forearms.

Sexual Abuse:� Some children may or may not have physical signs of abuse and be taken to the doctor to �rule-out� the potential.� Some children around 2-4 years of age will naturally �play� with themselves out of curiosity.� A child that plays with others, same sex or opposite sex, should raise a suspicion of abuse.� A child may also tell the caretakers of sexual knowledge that should not be know i.e. �sucking� or �touching down there�.� Many findings are non specific and should be cautiously approached.� Vague findings are that a child gets upset when they are bathed, sexually abused or they don�t like bathing?� Sometimes it is hard to tell.� However, other times things are more clear.� If a child has acquired a Sexually Transmitted Disease (Yeast infections are not considered an STD), there is a high probability that they have been sexually abused.� Often it is best if a concerned individual does not �put words in a child�s mouth.� It is better left to the medical professional to determine this.� However, asking a child to show were they were touched on a doll helps to separate them from this frightening picture.� Also it is extremely important to assure the child that you will not get upset or angry at them and even more important that you follow through with that promise.� Often, sexual abusers will use fear to keep a child quiet and this works very well.� Older children may show changes in their attitude, schoolwork, activity, etc.

Emotional Abuse and Neglect: This may present with a failure to thrive or gain weight.� They lack subcutaneous fat in the cheeks, buttocks, arms and legs.� They may act depressed.� Long term abuse may manifest in short stature and, although normal head size, their head may be larger appearing than their body.

Physical neglect:� This must be differentiated between the effects of poverty.� Usually the symptoms continue after adequate social services have been provided.� These parents and caregivers are unable to recognize the physical state of their child.

Munchausen syndrome by proxy: This presents often with dehydration from induced vomiting and/or diarrhea, signs of poisoning and some caregivers may go as far as injecting the child with an infection to induce sepsis.� This is usually detected by the physician or nursing staff.� The hallmark of these cases is children with repeated visits for unexplained illnesses.


Management and Reporting:
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With any of the above, physical illnesses and trauma should be treated.� Failure to thrive infants should be placed in a setting where they can be fed and weight gain observed.� If abuse or neglect is suspected, it should be reported to Child Protective Services or other Law Enforcement Agencies.� Emotional abuse will usually not be responded to except by parenting programs.� If Munchausen syndrome by proxy is suspected, judicial involvement is usually required.

Prevention:
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Physical Abuse:� Often those families at high risk respond to home visitor services.� These services often offered to the public make it as easy to call in help as it is to abuse their child.� In some cases, parental education classes may help by educating parents and caregivers to triggers which allows them to identify problems and get help before the child succumbs to abuse.

Sexual Abuse:� This is more difficult to prevent.� Most efforts involve training children to protect themselves and their �private parts� from harm.�

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