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Caregivers of Young Children: Preventing and Responding to Child Maltreatment
User Manual Series (1992)

Author(s):  U.S. Department of Health and Human Services Koralek

Year Published:  1992

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You are in section: Table of Contents Additional Acknowledgment Preface Acknowledgment Overview of Child Abuse and… 1 - Early Childhood Educational… 2 - Recognizing Child Abuse and… 3 - Reporting Child Abuse and… 4 - Minimizing the Risk of… 5 - Caring for Maltreated Children 6 - Supporting Parents and… Glossary of Terms Notes Selected Bibliography Other Resources

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Recognizing Child Abuse and Neglect

Making a Difference¹⁸

• Sandra is the mother of a 4-year-old girl, Kelly. Three months ago Sandra visited a community clinic for help to stop drinking and to separate from Kelly's father, Frank, who is also an alcoholic. Frank has physically abused Sandra and Kelly in the past, but both of them, especially Kelly, still feel close to him. Recently, Kelly has been very withdrawn and depressed.

  The counselor at the clinic suggested that Sandra find child care for Kelly as part of her treatment plan, both for her own peace of mind and for Kelly's safety. Because Kelly was at risk for abuse, the family was eligible for State-subsidized respite care. The counselor told Sandra about the local resource and referral (R&R) agency that could help her find child care and described the various types of care available. Kelly had never gone to child care before.

  Sandra received several referrals from the R&R and enrolled Kelly in a half-day child care program, where she is making friends and getting help from her caregivers in expressing her feelings. Sandra and Kelly are temporarily living in a shelter for women. During the time Kelly is at child care, Sandra attends a treatment program, looks for work and a new place to live, and gathers the strength she needs to start a new life.

  The clinic counselor keeps in contact with Kelly's child care program to share ideas on how to help the family and especially on how to handle Frank, who has become very angry about losing custody of Kelly.

• Ruth was 19 when her first son, Anthony, was born premature and very frail. She found Anthony very difficult to care for and sometimes shook or hit him when he cried for long periods. At age 3, Anthony was hospitalized with pneumonia at the same time that a second normal and healthy son, Brian, was born. Six months later, Ruth's husband left her. Ruth found a restaurant job and enrolled Anthony and Brian in her neighbor Marie's family day care home.

  At age 3½, Anthony was barely talking but had become very active, violent, and hard to control. Ruth favored Brian because he was an `easier' baby, but raising them both on her own was causing greater and greater strain. Ruth was fired from her job and started using severe physical punishment when she was angry. She began asking Marie for help.

  Marie told Ruth about some local counseling and support groups and took care of the boys occasionally in the evening or for part of the weekend, but she began to see that the punishment had become physical abuse. As required by law, Marie reported the abuse to the local child welfare agency and then told Ruth that she had done so. Ruth had become frightened enough of her own violent behavior that she was willing to accept intervention.

  The children spent over a year in foster care while continuing to attend Marie's program. Child care was their greatest comfort and continuity during this difficult period. Marie was able to get some free training from the local community health center on how to set firm limits for the two boys while showing them the affection they needed.

  The boys are now 7 and 4. Anthony, in a special class because of a learning disability, joins Brian at family day care after school each day. Marie still cares for the boys on occasional weekends. Anthony and Brian continue to be very challenging to care for, but Anthony has become much more confident about making friends. Learning to read is still very hard for him, but Marie is teaching him to play the guitar, since Anthony has always had an exceptional ear for music.

• Roberta and John are affluent, upwardly mobile working parents. Their 7-year-old son Steven attends second grade and an afterschool program. Three-year-old Lynn goes to a child care center. Both children are cared for by a housekeeper until late in the evening and frequently on weekends. Both Roberta and John are working toward advances in their careers; they are often away for evening meetings, work-related social events, and business trips.

  When they have time to spend with the children, they are often distracted, low-energy, and tense. They expect their children to be very bright and successful and sometimes find them disappointing. John is especially upset and critical about Steven's below-average performance in school.

  The teachers at Steven's afterschool program have begun to feel concerned about his withdrawn behavior and his lack of friends. He spends most of his time alone in fantasy play, which often involves grown-ups attacking or ridiculing the "baby." Lynn's preschool teachers are also concerned; she frequently whines and clings to adults and has had chronic colds and sore throats.

  Roberta and John did not take the afterschool staff's concerns very seriously until they began to hear from Lynn's preschool program. Parent conferences at both programs helped them understand that they have been neglecting their children's emotional needs.

  After nearly a year of discussion, both have made some adjustments and sacrifices. Steven and Lynn are slowly starting to join group activities with other children. John is beginning to confront his emotionally abusive relationship with Steven, which is very much like the pressure and ridicule he received from his own father.

• When Andrea graduated from high school she wasn't sure what kind of job she wanted. A friend suggested that she try working as a child caregiver. She came from a large family, and had always liked babysitting for her brothers and sisters ("little kids are so cute"), so she decided to apply for a job at the Bo Peep Child Development Center. Although she had no experience working with young children and had no formal education in child development or in meeting the needs of young children, Bo Peep's director, Ms. Kelly, offered her a job as an aide working with the toddler group. Ms. Kelly was sure that Andrea's positive attitude and love of children would be an asset to the program.

  Most of Andrea's training occurred on the job as she and the lead caregiver, Theresa, planned and carried out a program of activities for the 14 toddlers in their care. Theresa gave Andrea several articles on activities for toddlers and helped her learn about "what makes toddlers tick." Andrea thought it was all very interesting, but, as she was the oldest child in a family of seven, she already knew how to care for the children. She had seen four brothers and sisters grow up and knew how to keep them in line.

  Unfortunately, Andrea soon learned that dealing with a group of toddlers can be very demanding and stressful. She was exhausted by the end of each day. One minute a child would ask to be held and cuddled, and the next she would cry because she wanted to do something for herself.

  Theresa recognized that this was typical toddler behavior and created ways for the toddlers to express their independence. When a child yelled "no" it didn't bother her, and she calmly redirected the child to another activity. Andrea soon began feeling that Theresa was spoiling the children. Despite Theresa's attempts to help Andrea understand what toddlers were like and what they needed from adults, Andrea refused to listen. She would develop her own ways for handling the "problem" children.

  One day two of the children refused to put on their coats to go outdoors. Andrea grabbed them both by their arms and squeezed hard until the children both began wailing. Theresa turned and saw a red-faced Andrea and two screaming children. Theresa saw that Andrea had lost control, and stepped in to console the crying children, giving them both hugs and reassuring them that everything would be all right. Then she asked Andrea to take a break to regain control of her behavior. Andrea agreed to go take a walk around the neighborhood until she had calmed down.

  Later that day, Theresa and the program director met with Andrea and explained that her behavior was absolutely inappropriate for a caregiver. They suggested that Andrea might want to seek another kind of employment. Andrea willingly resigned her position, saying that she now understood that caring for young children required knowledge and skills that she did not have. In addition, she said that she didn't think that she had enough patience to do a good job working with a group of toddlers. Theresa and the program director thanked Andrea for her honesty and wished her good luck in her next job.

Caregiving professionals who have ongoing, daily contact with children are often able to detect and report suspected child maltreatment that otherwise might go unnoticed. To recognize and report child maltreatment effectively, it is necessary to have a common understanding of the various types of maltreatment and how they are defined.

The Child Abuse Prevention and Treatment Act, as amended by the Child Abuse Prevention, Adoption, and Family Services Act of 1988 (Public Law 100-294) defines child abuse and neglect as "the physical or mental injury, sexual abuse or exploitation, negligent treatment, or maltreatment

• of a child under the age of 18, or except in the case of sexual abuse, the age specified by the child protection law of the State
  
  
• by a person (including any employee of a residential facility or any staff person providing out-of-home care) who is responsible for the child's welfare
  
  
• under circumstances which indicate that the child's health or welfare is harmed or threatened thereby..."

The Act defines sexual abuse as "the use, persuasion, or coercion of any child to engage in any sexually explicit conduct (or any simulation of such conduct) for the purpose of

• producing any visual depiction of such conduct, or
  
  
• rape, molestation, prostitution, or
  
  
• incest with children..."

As a result of the Child Abuse Amendments of 1984 (Public Law 98-457), the Act also includes as child abuse the withholding of medically indicated treatment for an infant's life-threatening conditions.

Each State and community and many early childhood education programs also have definitions of child maltreatment. For example, Head Start and all branches of the military have specific definitions of child maltreatment. Caregiving professionals should find out what definitions are applicable in their community and program.

Evidence of each form of child abuse and neglect (physical abuse, neglect, sexual abuse, and emotional maltreatment) can be found in young children from birth through age 8. Sensitive early childhood education professionals can pick up clues of possible maltreatment by observing the child at the program or during routine conversations with parents. In addition, early childhood education professionals need to be alert to the behaviors of children and other staff within the program.

Physical signs of abuse or neglect are those that can actually be seen. Whether mild or severe, they involve the child's physical condition. Frequently, physical signs are bruises, bone injuries, or evidence of lack of care and attention manifested in conditions such as malnutrition.

Behavioral clues may exist alone or may accompany physical indicators. They might be subtle clues, such as a "sixth sense" that something is wrong, or sexual behaviors in young children indicating sexual knowledge not ordinarily possessed by young children, for example, sexual aggression toward younger children. Early childhood education professionals are trained to be skillful observers of children's behavior. They are aware of the range of behavior that is appropriate for children of a given age and are quick to notice when a child's behavior falls outside this range. Many programs maintain anecdotal records based on observations of individual children. Reviewing observation notes recorded over a period of time can provide useful information about changes in a child's behavior or pattern of development. These changes might indicate that the child is a victim of child abuse or neglect.

Early childhood education professionals have daily informal contacts with parents as they drop off and pick up their children from the child care center or family child care home, and more formal conversations during periodic parent conferences. During these conversations, parents might make statements about their children that indicate that they have abused or neglected their child or may be at risk for doing so. For example, a young mother comments, "Sam doesn't listen to anything I say. He is just like his father; I would be better off without him." A parent's negative comments or indifference to the child's progress in the program may cause the caregiving professional to observe the child more carefully to determine if the child shows any signs of having been maltreated.

Early childhood education professionals also use their observation skills to identify signs that child abuse and neglect might be taking place within their child care programs. For example, over a period of time a teaching assistant notices that several children avoid spending time alone with the teacher. She reports her concerns to the director. Or, a staff member sees a colleague slap a child who talked back to her or shake an infant who wouldn't stop crying. These behaviors should be considered to be child abuse and should be reported.

In the past, materials on recognizing child abuse and neglect included lists of physical and behavioral indicators for each of the types of abuse. These lists tended to be misleading, however, because recognition of child maltreatment is based on the detection of a cluster of indicators rather than observation of one or two clues. This chapter will help early childhood education professionals to recognize when a series of physical and behavioral indicators should lead them to consider the possibility of child abuse and neglect.

Physical Abuse

Physical abuse of children includes any nonaccidental physical injury caused by the child's caretaker. The abuse might take place in a single or repeated episodes. Although the injury is not an accident, the adult may not have intended to hurt the child. The injury might have resulted from overdiscipline or physical punishment that is inappropriate to the child's age. This usually happens when an adult is frustrated or angry and strikes, shakes, or throws a child. Occasionally, physical abuse is intentional. For example, it is highly likely that abuse is intentional when a caretaker burns, bites, pokes, cuts, twists limbs, or otherwise harms a child.

Young children frequently fall down and bump into things. These accidents may result in injuries to their elbows, chins, noses, foreheads, and other bony areas. Bruises and marks on the soft tissue of the face, back, neck, buttocks, upper arms, thighs, ankles, backs of legs, or genitals, however, are likely to be caused by physical abuse. The most common cause of child abuse-related deaths is head injuries.

When staff are changing diapers or helping children go to the toilet, they might see bruises or burns that were covered by clothing. Often, abusive parents are consciously or unconsciously aware that the signs of their abuse need to be concealed so they dress their children in long sleeves or long pants. Another sign to look for is bruises at various stages of healing, as if they are the result of more than one incident. The ages of bruises can be detected by the following consecutive colors:

• red
  
  
• blue
  
  
• black-purple
  
  
• green tint, dark
  
  
• pale green to yellow¹⁹

This is a biochemical process that happens in all children. However, it is more difficult to detect the color of bruises in children of color, particularly black children. A physician can distinguish the age and color of bruises in any child regardless of color.

Injuries to the abdomen or the head, which are two particularly vulnerable spots, often go undetected until there are internal injuries. Injuries to the abdomen can cause swelling, tenderness, and vomiting. Injuries to the head may cause swelling, dizziness, blackouts, retinal detachment, and even death. In particular, bilateral black eyes could be an indication of bleeding in the brain.

In addition to the physical signs that a child has been physically abused, the child might also exhibit behavioral signs. Some examples include:

• Jackie (3 years old) runs to her cubby to get her blanket whenever she hears another child crying. She clutches her blanket and rocks back and forth saying, "No hitting. No hitting."
  
  
• Daniel (2½ years old) is usually picked up by his mother. When his father comes to get him he screams and hides behind his family child care provider's legs. Earlier that day his provider overheard him playing with the dolls. He said, "I told you no wet pants. Now I'll beat your butt."
  
  
• Peter (3½ years old) resists his teacher's offers to tuck him in at nap time or sit in her lap to hear a story. In the past he has been a very affectionate child.
  
  
• Kathy (4 years old) causes havoc all morning when she repeatedly grabs toys from the other children. She spends the afternoon in the book corner sitting by herself and stroking her blanket.
  
  
• When she notices the big bruise on his arm, Troy (4½ years old) tells his mother, "Ms. Tracy squeezed my arm real hard, and I cried."
  
  
• Six-month-old Daniel lies quietly in his crib when he wakes up, looking around the room but not crying or attempting to get his caregiver's attention.

Child Neglect

Child neglect is characterized by failure to provide for the child's basic needs. Neglect can be physical (for example, inadequate clothing for cold weather), medical (for example, refusal to seek health care when a child clearly needs medical attention), educational (for example, failure to enroll a child of mandatory school age), or emotional (for example, chronic or extreme spouse abuse in the child's presence). Severe neglect often results in death, particularly in the case of very young children. While physical abuse tends to be episodic, neglect tends to be chronic. Neglectful families often appear to have many problems that they are not able to handle. It is often very difficult to facilitate change in the behavior of chronically neglectful families. In an early childhood program, neglect may also be chronic. For example, it might be standard practice for a program to leave infants in their cribs for most of the day, rather than providing a safe area for them to move about.

When considering the possibility of neglect, it is important to look for patterns. Do the signs of neglect occur rarely or frequently? Are they chronic (occurring almost every day), periodic (happening after weekends, vacations, or absences), or episodic (seen twice during a period when the child's mother was in the hospital)?

Some examples of signs that might indicate a child is being neglected include the following:

• Mrs. Samuelson, a family child care provider, had 10 children in her care (4 more than she is licensed to care for). The children are a handful, but her 12-year-old daughter, Kimberley, helps with the children when she comes home from school. One afternoon Mrs. Samuelson's neighbor calls and asks for a ride to a doctor's appointment. Her husband was supposed to take her, but he had an emergency at work and had to work late. Mrs. Samuelson wants to help this neighbor. Several times the neighbor has looked after the family child care children while Mrs. Samuelson ran an errand. She asks Kimberley if she thinks she can handle the children. "Oh sure," says Kimberley. "I'll just read them stories until you get back." While Mrs. Samuelson is gone, Kimberley gathers the children together and reads to them. One child says he is hungry. Kimberley says that they can have a snack when her mother returns. The hungry child stays put for a while, but then he wanders off into the kitchen looking for food. Kimberley doesn't notice that he is gone. The child stands on a chair to reach the cookies in the cupboard. He slips and falls, knocking his head on the corner of the counter. Kimberley hears him crying and rushes into the kitchen. She finds him lying on the floor with a bleeding forehead.
  
  
• Five-year-old Andrea tells her teacher she is tired this morning because her 6-month-old brother, Max, woke her up. She says, "My mommy wasn't home yet so I made Max a bottle and gave it to him. Then he finally went back to sleep."
  
  
• Geraldine (4½ years old) tells her father that she is very hungry because she didn't have any lunch. When he asks her why she didn't eat, Geraldine says that her teacher took lunch away from her and her friend because the two girls were playing instead of eating.
  
  
• David (4 months old) arrives at his family child care home with a severe diaper rash. The family child care provider, Mrs. Taylor, lets his mother know and asks for permission to use some ointment that will heal David's skin and protect it from further irritation. The mother says, "If you've got the time to put that greasy stuff on, go ahead." Mrs. Taylor uses the ointment all week and the rash goes away. She gives the mother the tube to take home and use over the weekend. On Monday morning David arrives with the rash again. This pattern is repeated over a 4-week period.

Nonorganic Failure To Thrive

A form of neglect that affects infants and young children is nonorganic failure to thrive. Failure to thrive may occur when a child does not grow or develop during the first 3 years of life. Failure to thrive is the diagnosis if the child's height, weight, or head circumference is less than the third percentile.²⁰ Typically, the child's weight will be below the third percentile with the child's head circumference and height above the third percentile. Organic failure to thrive is caused by a child's physiological problems, whereas nonorganic failure to thrive is due to environmental problems related to nurturing and/or feeding.²¹

The diagnosis of nonorganic failure to thrive caused by emotional deprivation or physical neglect is supported if the infant gains 1.5 ounces a day for 1 week in a "safe" environment (for example, the hospital). Infants may also have developmental delays, such as not being able to sit up or feed themselves. These children may exhibit additional physical symptoms, for example, vomiting or diarrhea, anemia, rashes, urinary tract infections, fevers, weakness, or extreme tiredness. A failure-to-thrive infant may be spastic and rigid or have extremely poor muscle tone. In the latter case, caregivers describe their appearance as "floppy." Most infants with failure to thrive are not able to move around. The caregiving professional should be concerned about the child who appears to have lost weight and be especially sensitive to an infant who has declined 25% from his/her growth curve.

Infants and young children may also exhibit behavioral signs of this type of neglect. Infants may be unresponsive and withdrawn. They do not respond to their caregivers' smiles and coos. They rarely cry or express any kind of frustration. Researchers studying these children report that they tend to avoid contact with their caregivers. When caregivers try to interact with these infants, they look away, actively cover their faces with a hand, or turn away to face the wall or some other inanimate object. The infants tend to scan their environment, not focusing on any single person or object.

Mothers of failure-to-thrive children may feel incompetent and unable to meet their children's needs. These mothers may have a low tolerance for irritation and seem angry and depressed. Often, the pregnancy of the child was neither planned nor wanted. These families are likely to need extensive family-centered counseling and training in appropriate parenting and nurturing techniques. Their children need a nurturing environment, including nutrition therapy and physical contact, and at times may need to be hospitalized.

Sexual Abuse

Sexual abuse includes a wide range of behavior: fondling a child's genitals, intercourse, rape, sodomy, exhibitionism, and commercial exploitation through prostitution or pornography. Sexual abuse may begin with inappropriate touching (for example, fondling) and progress to more intensive or traumatic forms of sexual abuse (for example, intercourse). These behaviors are contacts or interactions between a child or adult in which the child is being used for the sexual stimulation of the perpetrator or another person. Sexual abuse may be committed by a person under the age of 18 when that person is either significantly older than the victim or when the perpetrator is in a position of power or control over another child. For example, if a 14-year-old summer camp counselor touches the genitals of a 5-year-old who is in his care, this would be considered sexual abuse.

Sexual abuse may take place within the child's immediate family (referred to as incest)^* or at the hands of adult caretakers outside the family, for example, a relative (aunt, cousin, or grandfather), family friend, or a teenage neighbor. Boys as well as girls are vulnerable to sexual abuse, although statistically boys are not as likely to report as girls.²² This may be due to the socialization of boys, which teaches them that they should not acknowledge vulnerability and should be aggressors rather than victims.

Recently, media attention has focused on incidents of sexual abuse that have occurred in child care centers and family child care homes. Individuals who sexually abuse young children in child care settings might be family child care providers, caregivers, directors, support staff, bus drivers, or volunteers; in short, anyone who has access to the children. Abuse occurs most frequently in bathrooms while children are being assisted with toileting. For this reason, many centers have removed the walls from toilet stalls in bathrooms used by children aged 5 and under. A recent study defined the risk to children as 5.5 sexually abused children per 10,000 enrolled, which is lower than the risk that children might be sexually abused in their own households, 8.9 per 10,000 for children under 6 years of age.²³ Minimizing the risk of child abuse and neglect in child care centers and family child care homes is discussed in more detail later in this manual.

Sometimes children report sexual abuse immediately after an incident. Other times the abuse goes on for months or even years before the child reports it or before it is discovered by someone else. Many times, children do not report the abuse because the perpetrator has threatened that he/she will harm the child or the child's parents. In some cases, perpetrators tell children that they will be harmed by monsters or other creatures that young children are typically afraid of. Often, the abuser knows how to manipulate children and promises them gifts or attention in exchange for playing sex games.

The physical signs of sexual abuse include some that an early childhood education professional would notice while routinely caring for young children. For example, while helping the child use the bathroom, a caregiver may notice a child's torn, stained, or bloody underclothing or bruises or bleeding in the child's external genitalia, vaginal, or anal area. If a child says that it hurts to walk or sit or if he/she complains of pain or itching in the genital area, a caregiver should take note and watch to see if it is a recurring condition.

Young children who have been sexually abused may also exhibit behavioral signs of their abuse. They may show excessive curiosity about sexual activities or touch adults in the breast or genitals. Some children who have been sexually abused are very afraid of specific places, such as the bathroom or a bed. Sexually abused children may also act out their abuse using dolls or talking with other children about sexual acts. Such premature sexual knowledge may be a sign that they have been exposed to sexual activity. However, there is a great deal of controversy in the literature regarding the use of dolls, particularly anatomically correct ones, and whether demonstrations of interest in genitalia by young children should be construed as an indication of sexual abuse. Therefore, caregiving professionals should not encourage a child to demonstrate what might have happened to them using dolls unless they have received adequate training to conduct such assessments and are familiar with the research regarding the use of dolls.²⁴

Some examples of behavioral signs that might indicate a child is being sexually abused include the following:

• Five-year-old Marci displays precocious sexual behavior. Frequently, her teacher sees her off by herself masturbating. One afternoon, her teacher heard her asking one of the boys if he would show her his penis. On another occasion, the teacher saw her laying the dolls on top of each other. Marci whispered to one of the dolls, "I promise not to hurt you."
  
  
• A teacher is helping Jason (age 4) get to sleep at nap time. For several weeks, Jason has been having a hard time settling down. When he does fall asleep, he sometimes wakes up crying about monsters. Today, he turns to his caregiver and says, "I've got a secret, but I can't tell you what it is."
  
  
• The children in the preschool room are sitting at the table with their caregivers eating lunch. Nancy (3½ years old) is wiggling around in her seat a lot. Her caregiver asks her if she needs to go to the bathroom. Nancy says, "No, it's not that. My bottom hurts where Gary poked me." Gary is her 15-year-old brother.
  
  
• The children and caregivers are outside on the playground. Simone (age 4½) needs to go inside to the bathroom. Ms. Fox says, "I'll take her." The other caregiver, Ms. Young, says, "But it's my turn." Ms. Fox insists that she will take the child. Simone says, "I don't have to go any more." Ten minutes later Simone comes up to Ms. Young and says, "I want you to take me. You don't hurt me."

Emotional Maltreatment

Emotional maltreatment includes blaming, belittling, or rejecting a child; constantly treating siblings unequally; or a persistent lack of concern by the caretaker for the child's welfare. It also includes bizarre or cruel forms of punishment (for example, locking a child in a dark closet). This type of abuse is the most difficult form of child maltreatment to identify because the signs are rarely physical. The effects of mental injury, such as lags in physical development or speech disorders, are not as obvious as bruises and lacerations. Sometimes children exhibit behavior such as facial tics, rocking motions, and odd reactions to persons in authority. Some effects might not show up for many years. Also, the behaviors of emotionally abused and emotionally disturbed children are often similar.

While the behavior of emotionally maltreated and emotionally disturbed children is similar, watching how parents behave can help to distinguish disturbance from maltreatment. The parents of an emotionally disturbed child generally accept the existence of a problem. They show concern for the child's welfare and are actually seeking help. The parents of an emotionally maltreated child often blame the child for the problem (or ignore its existence), refuse all offers of help, and are unconcerned about the child's welfare.

Although emotional maltreatment does occur alone, it often accompanies physical or sexual abuse. Emotionally maltreated children are not always physically abused, but physically abused children often are emotionally maltreated as well.

An example of signs that might indicate a child is being emotionally maltreated includes the following:

• Each time he comes to pick up Nathan (5½ years old), Mr. Wheeler makes fun of his son's efforts. Typical comments include: "Can't you button that coat right. You never get the buttons lined up with the holes. You look like an idiot." "What's that a picture of? Is that the only color you know how to use?" "Can't you climb to the top of the climber yet? All those other kids climbed to the top. What's the matter with you, are your legs too short?"

Emotional abuse may also result from family violence, that is, children witnessing physical and emotional assaults between their parents. An example follows:

• Martina is making her first home visit to the Peterson family: Mrs. Peterson and her three young children. She rings the door bell and waits a long time for Mrs. Peterson to come to the door. She can hear lots of noise inside the apartment: loud music, adults arguing, and children crying. She rings the bell again, thinking that perhaps they did not hear her. Finally, the door opens and a man pushes his way past her. She looks inside and sees Mrs. Peterson bent over and holding her stomach. The three children are standing in the kitchen doorway holding onto each other. They look very scared, but they are not crying.

Emotional maltreatment may also take place in a child care setting when an early childhood professional uses words that belittle or shame a child, gives the child dirty looks, or consistently ignores a child. An example follows:

• Yolanda (3 years old) was so busy playing with her friends in the house corner that she wet her pants instead of using the toilet. Ms. Warner notices the girl's wet pants and walks over to the house corner. With her hands on her hips, Ms. Warner sternly says, "Well, Yolanda, I see that you aren't just playing house, you really are a baby. Only a baby would wet her pants. You're going to have to go back to the baby room if you can't keep your pants dry. Only big girls who can use the toilet can be in this room." Yolanda bursts out crying and runs to find the other teacher in the room.

Cultural Differences²⁵

In the United States, people come from many different cultures: African American, Asian, European, Hispanic, and Native American, to name a few. During the past 20 years, the United States has experienced a great influx of immigrants from all over the world: Afghanistan, Cambodia, Cuba, El Salvador, Ethiopia, India, Iran, Mexico, Nicaragua, the Philippines, Thailand, Vietnam, and so on. Because the children and families served by early childhood education programs reflect this cultural diversity, it is extremely important that caregivers of young children learn about and show sensitivity to the cultures and ethnic groups of the children in their care. This sensitivity will help caregivers distinguish between cultural child-rearing practices that are merely different and those that are defined by law as abusive or neglectful.

Caregivers may encounter some parents whose values or customs are different from their own. When this happens, caregiving professionals should take an honest and direct approach and ask the parents to explain their views and beliefs so that they can better understand the environment in which the child is being raised.

Child-rearing practices vary among families, cultures, and ethnic groups. In some families, children are expected to obey their parents without questioning the reasons for a parent's request. In many cultures, children are taught not to express negative feelings or opinions in front of their elders. While some cultures teach children to avoid making eye contact with adults, others chastise children who do not make eye contact: "Look at me when I'm talking to you." Most early childhood education programs in the United States encourage children to be independent because educators believe that this helps children to develop positive self-esteem. Yet many cultures encourage preschoolers to be dependent on their parents until they are school age, believing that young children need to feel that they will be taken care of. Clearly, there can be more than one right way to care for young children.

It is important to remember, however, that legal definitions of child abuse and neglect are not flexible. Even when an abusive practice is considered to be a cultural practice, it is still child abuse, and caregivers of young children are mandated to report it.

Observing Children Over Time

In high-quality early childhood programs, caregivers, family child care providers, and others who work directly with the children conduct numerous scheduled and spontaneous observations of the individual child participating in the program. These observations provide valuable information about the child's strengths, needs, interests, and progress. Over time, the written records of these observations provide a history of the child's life in the program. When the child's behavior changes suddenly, reviewing the observation records might provide clues to the causes for the child's sudden fears, hostility, or passivity.

Observers should watch and listen to the children, writing down what children do and say as it happens. Recordings should be as objective as possible, reporting the facts rather than reflecting opinions or drawing conclusions. For example, when watching two children arguing over a toy, an objective recording would state: "Tom grabbed the block from Andrew," rather than "Tom was bad today; he grabbed a block from Andrew," or "Jimmy came to the center today with a dirty diaper, for the third time this week," rather than "Jimmy was a mess." Objective recordings allow the caregiver to focus on the present and what actually occurs. Care providers can interpret their observations when they have time to read the notes, review the notes from previous observations of the child, and discuss their thoughts with colleagues or supervisors.

To get a total picture of the child, caregivers must observe children at different times of the day, alone and with other children or adults, indoors and outdoors, and in different settings. A child may behave quite differently while having his/her diaper changed than he/she does while crawling in the play area. Also, a single observation cannot provide a complete picture of a child. Observations are most useful when they are conducted regularly throughout the time the child participates in the program, for example, at least weekly. At times, the caregiver may find it helpful to ask another adult to conduct an observation of a child whose behavior is troubling. This second observation might provide a new perspective on what is causing the child's upsets. Children should be observed more frequently if there is a suspicion of maltreatment.

Observation records are used in planning, individualizing, evaluating, and reporting to parents. They also can be used to identify signs that a child has been abused or neglected. When an early childhood education professional first observes signs of possible abuse or neglect, he/she should review the observation records to see if there are patterns of behavior. For example:

• A caregiver notices that Marisa (34 months), who is usually a poor eater, asks for extra helpings at lunch. A review of the observation records shows that Marisa has asked for extra food several times in the past 3 months. In addition, the observation records have documented that she has had several unexplained stomach aches and numerous toileting accidents. The caregiver sees the look of terror on Marisa's face when her grandfather unexpectedly comes to pick her up. She knows that it's time to discuss her suspicions with a colleague.

If the observations reinforce suspicions of child maltreatment, then a report must be filed. The observation records will become part of the documentation for the report. Although the notes are confidential, they can be requested by CPS or a law enforcement agency. If one of these agencies requests the records, then the caregiver must provide them. The agency will use these records to investigate the allegation further so that the child and family can begin receiving treatment.

Recognizing Child Abuse and Neglect Through Conversations and Interviews

Early childhood programs are generally family oriented, providing a great deal of formal and informal communication between program staff and families of the children in the program. Caregivers may gather important information about the family from routine conversations with parents and children. During daily dropoff and pickup times and at scheduled conferences, parents provide details of family life, discuss discipline methods, or ask for help with problems. Young children enjoy talking about their families so they, too, may provide information about the family's interactions and home life.

Conversations with the parent can provide clues to how the parent feels about the child. The presence of child abuse and neglect may be indicated if the parent constantly:

• Blames or belittles the child ("I told you not to drop that. Why weren't you paying attention?").
  
  
• Sees the child as very different from his/her siblings ("His big sister Terry never caused me these problems. She always did exactly what she was told to do.").
  
  
• Sees the child as "bad," "evil," or a "monster" ("She really seems to be out to get me. She's just like her father, and he was really an evil man.").
  
  
• Finds nothing good or attractive in the child ("Oh well. Some kids are just a pain in the neck. You can see this one doesn't have anything going for her.").
  
  
• Seems unconcerned about the child ("She was probably just having a bad day. I really don't have time to talk today.").
  
  
• Fails to keep appointments or refuses to discuss problems the child is having in the program ("That's what I pay you for. If she's getting into trouble it's your job to make her behave.").
  
  
• Misuses alcohol or other drugs.

When the caregiver knows a family well, he/she is in a better position to gauge whether a problem may be child abuse and neglect or something else, a chronic condition or a temporary situation, a typical early childhood problem that the program can readily handle, or a problem that requires outside intervention. Family circumstances may also provide clues regarding the possible presence of abuse or neglect. The risk of abuse or neglect increases when families are isolated from friends, neighbors, and other family members or if there is no apparent "life-line" to which a family can turn in times of crisis. Marital, economic, emotional, or social crises are some causes of family stress that can lead to child abuse or neglect.

When considering the possibility of child abuse and neglect, a caregiver of young children may want to talk with a child about a particular incident. Before having this conversation, the caregiver must be convinced that such a conversation will not put the child in further danger. Such a conversation is appropriate provided it is handled nonjudgmentally, carefully, and professionally.

Remember, an early childhood education professional does not need to prove child abuse or neglect beyond a reasonable doubt before reporting. All he/she needs is to have a reasonable ground for suspecting the presence of abuse or neglect. It is CPS' role to conduct a thorough investigation to determine whether child abuse and/or neglect exists.

Talking With the Child

When children's verbal skills are advanced enough for them to participate in conversations, they may be able to answer questions about their injuries or other signs of maltreatment. The caregiver should keep in mind that the child may be hurt, in pain, fearful, or apprehensive. Every effort must be made to keep the child as comfortable as possible during the discussion.

The primary purpose for the discussion is to gather enough information from the child to make an informed report to the CPS agency. Once the essential information has been gathered, the caregiver should conclude the conversation. When the early childhood education professional is talking with the child, he/she is not conducting an interrogation and is not trying to prove that abuse or neglect has occurred.

The person who talks with the child should be someone the child trusts and respects, such as a caregiver, family child care provider, or teacher. The conversation should be conducted in a quiet, private, nonthreatening place that is familiar to the child. In nice weather, a pleasant spot outdoors might be appropriate.

For example, a teacher might see the child alone in the book corner reading a book. She could sit with the child, strike up a conversation, and try, in the course of the conversation, to steer the discussion toward his/her injuries. She might say, "I noticed that new bruise on your arm this morning. It must have hurt when you got it. Would you like to talk about it?" The teacher should then wait to see if the child wants to talk about the bruise or change the subject to something else. If the child changes the subject, the teacher should go along with the change in conversation and not push the child to talk about the injury.

When children are willing to discuss their injuries, they should be reassured that they have done nothing wrong. Maltreated children often feel, or are told, that they are to blame for their own abuse or neglect and for bringing trouble to the family. Therefore, it is important to reassure children that they are not at fault. The caregiving professional talking with the child must be very careful not to show any verbal or nonverbal signs of shock or anger when the child is talking about what happened to cause the injury.

It is important for caregivers of young children to use terms and language the child can understand. If a child uses a term that is not familiar (such as a word for a body part), the caregiving professional may ask for clarification or ask the child to point to the body part he/she means. Caregivers of young children should not make fun of or correct the child's words; it is better to use the same words to put the child at ease and to avoid confusion. If the child is showing sexual knowledge that is inappropriate for that age group, the caregiver could ask in a quiet, low-key tone, "Where did you learn about...?"

Children should not be pressed for answers or details that they may be unable or unwilling to give. For example, it would be inappropriate to ask, "Did you get that bruise when someone hit you?" If the child changes what he/she has already said, the caregiver should just listen and note the change. The caregiving professional should not ask "why" questions. Caregivers of young children can actually do the child more harm by probing for answers or supplying the child with terms or information. Several major child sexual abuse cases have been dismissed in court because it was felt that the initial interviewers biased the children.

If children want to show their injuries, the caregiver should allow them to do so. But if a child is unwilling to show an injury, the caregiver should not insist, and, of course, no child should be pressed to remove clothing.

Caregivers must be sensitive to the safety of the child following the disclosure; the child might be subject to further abuse if he/she goes home and mentions talking with someone at the program. If a caregiver of young children feels that the child is in danger, CPS should be contacted immediately. Support from CPS may provide protection for the child. A CPS caseworker may need to interview the child at the program. If so, the program should provide a private place for the interview, and a caregiver, teacher, or provider whom the child trusts should be present throughout the interview. If it is necessary for the CPS caseworker to remove the child from the program for a medical examination, caregivers should request a written release from the CPS caseworker.

Talking With the Parent(s)

There are several points at which caregivers of young children might want to communicate with a parent about suspected child abuse and neglect. These points range from a teacher observing some possible signs of child maltreatment and wanting to get to know the family better to letting parents know that someone at the program has filed a report of suspected child abuse and neglect.

The caregiver should confer with supervisors or colleagues to identify the most appropriate person to meet with the parents. In some cases, this will be the person who provides direct care for the child: the caregiver or teacher. In other cases, the program director, social worker, education coordinator, or mental health specialist will be preferred. Sometimes a team approach is best, with the person who works closest with the child accompanied by an administrator or support staff. If a family child care provider is part of a network, he/she may want to have a colleague or supervisor present.

It is never appropriate for a caregiving professional to try to "prove" a case of maltreatment by accusing parents or demanding explanations for a child's injuries or behavior. At the same time, if a teacher fears that the discussion of possible maltreatment might make the child even more vulnerable to abuse, it is essential to talk with CPS prior to scheduling or conducting the meeting with the parents.

Parents may be apprehensive or angry at the prospect of talking with the program staff about an injured or neglected child. The caregiver may know the parents well from daily interactions with them and because their child has been in the program for a long time. The caregiving professional should hold the meeting in a private place and try to make the parents as comfortable as possible. At the beginning of the conversation, the caregiver must clearly explain the reasons why the meeting was called. If program staff have taken any action or will in the near future (filing a report of suspected child maltreatment, for example), the legal authority for the action should be explained. Parents may not realize that early childhood education professionals are mandated to report suspicions of child abuse and neglect.

In talking with the parents, the early childhood education professional should respond in a professional, direct, and honest manner. If parents offer explanations, staff members may demonstrate empathy. Staff should never display anger, repugnance, or shock. Keeping in mind that situations that appear to be maltreatment might turn out to be something else, caregivers should avoid placing blame or making judgments or accusations.

It is important to assure parents that the discussion is confidential; however, make it clear whether some of what is discussed must be revealed to a third party (for example, the CPS agency). Caregivers of young children should avoid prying into matters extraneous to the subject at hand and never betray the child's confidence to the parents (for example, it is inappropriate to say, "Your child said...").

Parents have a right to know that a report has been made. They need to hear that the program will continue to support them through this difficult time. The caregiving professionals should let parents know that program staff care about them and their child and will continue to provide the same high-quality care as in the past. It is important not to alienate the family. Family members will be more open to assistance if they know that staff members are willing to help.

When program staff do not tell the parents, they often feel betrayed or that someone has "gone behind their back." In these instances, the parents are not likely to trust the program staff and may remove their child from the program. Also, although CPS is mandated not to reveal the name of the referral source, the parents nearly always know where the report has come from, and attempts at concealment only anger them further.

The chart following this page (Figure 1) summarizes the points discussed above. Spaces are provided for early childhood education programs to add their own interviewing tips based on local policies and procedures.

View Figure 1

Summary

When working with young children and their families, it is not easy to remain objective about the signs of abuse and neglect. Knowledge of the children and their families cannot help but influence how a caregiver interprets a child's physical injury or behavior. An educator may ignore signs and think that this child's mother or father, or his/her colleague, couldn't possibly be abusive or neglectful. The response of the caregiving professional will also be influenced by cultural values, personal values, and training. The early childhood educator must remember that abuse and neglect occur in all kinds of families. Parents who maltreat their children come from every race, income level, gender, and culture.

Despite this warning that personal biases and feelings will influence the ability to recognize child abuse and neglect, caregivers of young children should remember that sometimes it is extremely difficult to recognize abuse and neglect. It is crucial to remember that there are large gray areas that might be considered abuse or neglect by some people and not others. Families may frequently pass in and out of this gray area, and this movement influences the way the family is labeled and treated.

The caregiver's responsibilities regarding child abuse and neglect include recognition followed by reporting. The staff member is not responsible for investigating an occurrence of suspected abuse or neglect. Once the signs lead to a suspicion of child abuse or neglect, a report must be filed. The caregiver is not required to prove these suspicions. How, when, and where to file reports of suspected child maltreatment are discussed in the next chapter.

* Some experts refer to this abuse as incest only if the family member lives within the immediate household. Others group all close relatives under incest. There are also differences in the classification of abuse at the hands of unrelated persons living with the child, for example, mother's live-in boyfriend.

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You are in section: Table of Contents Additional Acknowledgment Preface Acknowledgment Overview of Child Abuse and… 1 - Early Childhood Educational… 2 - Recognizing Child Abuse and… 3 - Reporting Child Abuse and… 4 - Minimizing the Risk of… 5 - Caring for Maltreated Children 6 - Supporting Parents and… Glossary of Terms Notes Selected Bibliography Other Resources

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Updated on October 9, 2009