About Child Abuse:What is Child Abuse? The California Definition

This article is copyrighted and posted with permission of Cathy Kauffman at the Child Abuse Prevention Council of Sacramento. The article was originally posted at http://www.capcsac.org/abuse

What is Child Abuse? The California Definition

A child is a person who has not attained the age of 18.

Any act of omission or commission that endangers a child’s physical or emotional health and development.

What is Child Abuse? The Federal Definition

A child is a person who has not attained the age of 18.

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.

At a minimum, an act or failure to act which presents an imminent risk of serious harm.

Categories of Abuse

• Physical Abuse
• Physical Neglect
• Sexual Abuse and Exploitation
• Emotional Abuse

Physical and Behavioral Indications that Child Abuse May be Occurring

• These indicators, or “red flags” are the things you might see, which might give you the suspicion that child abuse has occurred or is occurring.
• Below, you will be given lists of typical indicators for each type of abuse. However, here are no hard and fast rules on what indicator would be seen with a particular type of abuse. For example, bed-wetting is listed under sexual abuse, but it may also be found in instances of physical abuse.
• These indicators alone may not warrant a report, however, if in sufficient number and strength may indicate abuse.

Physical Abuse—California Penal Code Section 11165.3-11165.6

• Physical injury inflicted on a child by other than accidental means.
• Willful cruelty or unjustifiable punishment of a child where a person willfully causes or permits any child to suffer, or inflicts thereon unjustifiable physical pain or mental suffering.
• When a person willfully causes or permits the person or health of the child to be placed in a situation such that this or her person or health is endangered.
• Unlawful cruel or inhumane corporal punishment resulting in a traumatic condition.

Physical Abuse—Federal Guidelines

• Physical injury as a result of punching, beating, kicking, biting, burning, shaking or otherwise harming a child.
• The parent or caretaker may not have intended to hurt the child, rather the injury may have resulted from over-discipline or physical punishment.

The Four Distinct Characteristics of Non-Accidental Injuries

• Location of the injury
• Pattern of the injury
• Correlation of the story to the injury
• Degree or extent of the injury

Location of the Injury

• Injury from abuse is most often located on the following areas:
• Head and neck area
  • This area is vulnerable to injury because of a child’s small stature…it may the closest body part to an adult’s hand or fist. Also, it is often targeted as it is where the crying, back talk, sass, bad language, etc. is emanating from. The area of the head covered by hair may be targeted as the hair covers any bruising or lumps.
• Hands are targeted as they are actively exploring or “getting into things”
• Upper arms
• Front and backs of thighs
• Genital area
• Stomach
• Back
• Buttock
• “Normal” childhood injuries are typically located on areas where the skin is close to the bone, such as:
  • shins
  • knees
  • hips
  • elbows
  • lower arms
  • hands

Pattern of the Injury

• Injury or bruises in a pattern which reflects the object used – a belt buckle, a handprint (the hand is the most common object used), knuckles, bottom of an iron, etc.
• Frequency of and/or recurrent injuries to the same site – child abusers often injure their victim in the same manner or use the same implement
• Clustered bruises
• Human bite marks – this might be found in sexual abuse cases as well as physical abuse.
• Two black eyes – it is very unusual to have two black eyes unless you have been in a car accident, or have broken your nose

Correlation of the Story

• The parent and/or child tell conflicting or confusing stories on how the injury occurred
• Treatment is delayed for fear of being caught
• Hospital or Doctor “hopping” to avoid suspicion because of frequent visits
• County “hopping” to avoid CPS intervention
• School “hopping” to avoid suspicion from school personnel
• Poisoning, especially in children under 6 months and over 6 years of age – children over six generally “know better” and children under 6 months are not “mobile.”

Conditions That Could Be Mistaken for Child Abuse

• Children with hemophilia, low blood platelet count or Leukemia tend to bruise easily.
• A Mongolian Spot is a deep purple/bluish/grayish birthmark which looks like a bruise. They can be anywhere on the body, but typically are on the buttocks and lower back. Mongolian spots are commonly found in African Americans, Asians and Hispanics.
• Impetigo is a skin condition with sores that look like crusty, healing burns.

General Indicators of Physical Abuse

• Indication of abuse often remains on the body
• If a child discloses that abuse is/has occurred, it should be taken seriously
• Any injury which is unusual for child’s age or development
• Shaken Baby Syndrome
• Retinal Hemorrhage
• Unexplained vision or hearing problems
• Lacerations/abrasions which are not regular childhood-type injuries
• Skeletal injuries and/or multiple fractures on different parts of the body
• Internal or abdominal injuries
• Absence of hair due to pulling
• Injuries from pulling or twisting
• Injuries in various stages of healing
• Moves stiffly or gingerly

Bruises

• Bruises in various stages of healing
• Bruises that regularly appear after absences, weekends or vacations.
• Bruises of any kind on an infant, especially on the face and buttocks
• Clustered bruises
• Bruises reflecting the shape of the object used, such as the hand, belt buckle,

Burns

• Burns in unusual places such as the soles of feet, palms of hands, buttocks, etc.
• Perfectly round burns the size of a cigarette tip or car lighter.
• Burns reflecting the pattern of the electrical appliance used, such as BBQ starter.
• Rope burns on limbs, neck or torso
• Scalding burns are the most common. Deliberate immersion burns will leave distinct waterlines such as:
• Burns resembling sock-like or mitten-like markings on the hands or feet
• “Doughnut” burn pattern on the buttocks – the child was pressed against in the bottom of the tub so forcibly, water doesn’t come in contact with the center part of the buttock A child accidentally falling into scalding water would have splash or irregular shaped burns, not distinct lines
• No burns in areas where the child has “flexed” in reaction to what was happening, I.e., arms tightened and folded against body, folds in the stomach, thighs against abdomen.
• Scalding burns on the back – child was probably trying to run away from perpetrator.

Behavioral Indicators of Physical Abuse

• Child is uneasy or frightened when discussing injury
• Parent or child is overly passive or aggressive
• Child overly afraid or protective of parent
• Lags in development
• Bullies other children to “get even’ with the world
• Constantly alert to danger
• Runs away
• Head banging
• Extreme or inappropriate reaction to pain
• Clinging
• Destructive behavior toward self and others
• Inappropriate dress to hide injury
• Chronic absence or tardiness in school
• School difficulties
• Arriving early and leaving late from school to avoid going home
• Wary of physical contact
• Parent may send child to school with the subconscious hope that someone will recognize the problem
• Parent responds inappropriately to the seriousness of the problem
• Parent hostile or antagonistic when talking about the problem

Sexual Abuse and Exploitation—California Penal Code Section 11165.1

• Sexual abuse is defined as sexual assault or sexual exploitation of a minor.
• Rape
• Statutory Rape
• Gang Rape (Rape in Concert)
• Incest
• Sodomy
• Oral Copulation
• Lewd and Lascivious Acts
• Child Molestation
• Penetration of the genital or anal opening, no matter how slight, by any object or body part whether or not there is the emission of semen. This does not include acts performed for a valid medical reason.
• Sexual contact between the genitals or anal opening of one person and the mouth or tongue of another person.
• Touching of genitals or intimate body parts or the clothing covering them for the purpose of sexual arousal or gratification. This does not include acts which are normal caretaker responsibilities or for a valid medical purpose.
• Masturbation in the presence of a child.
• Preparing, selling or distributing child pornography.
• Child prostitution or a live performance involving obscene sexual conduct with a child.

Sexual Abuse and Exploitation—Federal Guidelines

• The employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct.
• The rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children.

General Indicators of Sexual Abuse

• Child reports abuse – this is a big, bold, scary step for the child to take in breaking out of the “conspiracy of silence” and should be taken very seriously.
• Sexualized behavior, curiosity, or knowledge inappropriate for age
• Torn, stained or bloody undergarments
• Sexually transmitted diseases
• Pregnancy
• Genital discharge or infection
• Trauma or injury to genital or anal area
• Difficulty in walking, sitting urination or defecation due to genital or anal pain
• Excessive/compulsive masturbation
• In boys, excessive concern about homosexuality or homophobia
• Sexual victimization of other children
• Self-destructive behavior or suicide threats
• Withdrawal or depression
• Sudden acquisition of money, clothes or gifts
• Animal abuse
• Fire setting

Indicators in Younger Children

• Bed and pants wetting or fecal soiling
• Eating disturbances
• Unusual fears or phobias
• Overly compulsive behavior
• Change in school performance
• Pseudo-maturity or regressive behavior
• Inability to concentrate
• Sleep disturbances
• Frightened of caretaker or of going home

Indicators in Older Children and Teens

• Chronic fatigue, depression or apathy
• Excessive bathing
• Purposefully making themselves unattractive through poor hygiene
• Poor peer relations and social skills
• Overly compliant, aggressive, antisocial or delinquent behavior
• Running away
• Alcohol or drug use
• Prostitution or promiscuity
• Inappropriately seductive behavior
• Unusual fear of pelvic exams
• Drop in school performance
• Chronic absence or tardiness
• Arrives early at school and stays late to avoid being home
• Refusal to dress for P.E.
• Non-participation in activities
• Fearful of showers or restrooms
• Fearful of home life
• Fearful of males
• Overly self-conscience of body
• Crying without provocation
• Fire setting
• Eating disorders
• Early marriage to avoid abusive situation

Behaviors that MAY be seen in a Sexually Abusive Person

• Drug or alcohol abuse or other addictive behavior
• Mood changes
• Last to go to bed, or up during the night
• Sexual preoccupation
• Views child pornography
• Cruising
• Exhibitionism
• Seeks out relationships with children over adults
• Erratic discipline
• Prolonging physical contact with children…wrestling, tickling, bathing
• Walks in on child while bathing or using the toilet
• Interferes with child’s normal friendships
• Relates to the child with sexual undertones or manner

Why does the non-abusing parent often look the other way?

• They maybe in denial that their partner is capable of doing such a thing
• They may have been sexually abused as a child
• They may fear the loss of their partner or financial stability
• They may fear reprisal from partner for confronting the situation

Physical Neglect—California Penal Code Section 11165.2

• Physical neglect is defined as negligent treatment or the maltreatment of child by a person responsible for the child’s welfare, including both acts or omission of care.

General Neglect

• General neglect is the unwillingness of the parent or caretaker to provide for adequate basic needs, where there is no physical injury or injury is not likely to occur.
• The failure to provide adequate:
  • Food
  • Clothing
  • Supervision
  • Medical, dental or psychiatric care

Severe Neglect

• Severe neglect is the unwillingness of the parent or caretaker to provide for adequate basic needs, where there is physical injury or injury is likely to occur, such as:
  • Malnutrition
  • Non-organic failure to thrive
  • Chronic neglect
  • Abandonment
  • Willful endangerment
  • Refusal to seek medical care for serious conditions

Physical Neglect—Federal Guidelines

• Neglect can by physical, educational, or emotional.
• Physical – refusal of or delay in seeking health care
• Educational – chronic truancy, failure to enroll in school, failure to attend to special educational needs.
• Emotional – inattention to the child’s need for affection, refusal of or failure to provide needed psychological care, spousal abuse in the presence of the child, permission to use drugs or alcohol by the child
• Assessment of child neglect needs consideration for cultural values and standards of care as well as failure to provide, may be related to poverty.

Examples of Physical Neglect

• Children not being fed:
  • No food available
  • Food intentionally withheld
  • Children complain of hunger
  • Children beg or steal food
• Lack of adequate shelter:
  • Hazardous conditions (exposed wiring, broken glass)
  • Unsanitary conditions (garbage, spoiled food, excrement)
  • Lack of plumbing or other utilities
  • Homelessness where there are significant risk factors that place the child in imminent danger
• Lack of Supervision
  • Children left in the care of children who are unable to care for them
  • Abandonment
  • Any child left without supervision who is at risk due to age, environmental risks or personal limitation, especially those under age 8
  • Truancy issues should be referred to the school district
• Lack of Adequate Clothing/Personal Hygiene
  
  • Clothing inadequate or inappropriate for weather
  • Persistent skin disorders or severe diaper rash due to improper hygiene
• Lack of Medical or Dental Care
  • Untreated injuries
  • Failure to comply with medical treatment, posing a risk to the child’s health
  • Chronic lice with scabbing or secondary infection
  • Failure to thrive
  • Lack of attention to serious dental problems
• Failure to Protect
  • Failure of parent or caretaker to protect child from known situations of child abuse in any of its forms
• Behavioral Indicators of Physical Neglect
  • Listlessness
  • Hunger
  • Hoards food
  • Depression
  • Apathy
  • Anti-social
  • Infantile behavior
  • Anger
  • Fatigue
  • Delayed developmentally
  • Poor growth pattern or obesity
  • Extremes in behavior

Emotional Abuse—California Penal Code Section 11166[b]

• Emotional abuse is defined as when a person causes or permits a child to suffer unjustifiable or significant mental suffering.

Emotional Abuse—Federal Guidelines

• Acts or omissions by parents or caretakers that have caused, or could cause, serious behavioral, cognitive, emotional or mental disorders.
• Some acts, do not leave evident harm to the child but warrant reporting, such as extreme or bizarre forms of punishment, such as locking a child in a closet.
• Emotional abuse is almost always present when other forms of abuse are identified

Emotional Abuse

• Belittling
• Blaming
• Sarcasm
• Rejection
• Corruption
• Screaming
• Humiliation
• Threatening
• Name calling
• Unpredictable responses
• Child exposed to domestic violence
• Isolation of the child from social contacts
• Deliberate withholding of love and affection
• Child placed in restraints, caged or severe confinement

Indicators of Emotional Abuse in the Child

• Withdrawn, seeks isolation or is unresponsive
• Overly rigid or passive
• Repetitive, rhythmic movements
• Sleep, eating or speech disorders
• Learning problems
• Destructive to self or others
• Poor self-image and esteem – may unwittingly say “I’m bad…my daddy tells me so.”
• Hungers for attention and affection
• Failure to Thrive Syndrome

Indicators of Emotional Abuse in the Parent

• Has unrealistic expectations of the child – developmentally, educationally or emotionally
• Enforces unusual penalties or vaguely sinister punishment – it is one thing to place a child in time-out in their room for five minutes, and another to place a child in time-out in a locked closet for five minutes
• Uses child to satisfy their own ego needs
• Describes the child as bad, different, worthless or evil
• Refers to the child as “It”
• Uses child as a battleground for problems