Child Abuse Identification and Reporting: The Pennsylvania Requirement _____________________________
Some of the types of behaviors and symptoms discussed in the definitions of physical, sexual, and serious mental injury are also warning signs. For example, any of the injuries that may result from bodily injury, such as a child presenting with bruises in the shape of electric cords or belt buckles, should be considered risk factors for abuse. CONSEQUENCES OF CHILD ABUSE The consequences of child abuse and neglect vary from child to child, and these differences continue as victims grow older. Several factors will mediate the outcomes, including the [17]: • Severity, intensity, frequency, duration, and nature of the abuse and/or neglect • Age or developmental stage of the child when the abuse occurred • Relationship between the victim and the perpetrator • Support from family members and friends • Level of acknowledgment of the abuse by the perpetra- tor • Quality of family functioning In examining some of the effects of bodily injury, it is helpful to frame the consequences along a lifespan perspective [3]. During infancy, bodily injury can cause neurologic impairments. Most cases of infant head trauma are the result of child abuse [19]. Neurologic damage may also affect future cognitive, behavioral, and developmental outcomes. Some studies have noted that, in early childhood, physically abused children show less secure attachments to their caretakers compared to their non-abused counterparts [20]. By middle to late childhood, the consequences are more nota- ble. Studies have shown significant intellectual and linguistic deficits in physically abused children [3]. Other environmental conditions, such as poverty, may also compound this effect. In addition, a number of affective and behavioral problems have been reported among child abuse victims, including anxiety, depression, low self-esteem, excessive aggressive behaviors, conduct disorders, delinquency, hyperactivity, and social detachment [3]. Surprisingly, there has been little research on the effects of childhood bodily injury on adolescents [3]. However, differ- ences have been noted in parents who abuse their children during adolescence rather than preadolescence. It appears that lower socioeconomic status plays a lesser role in adoles- cent abuse as compared with abuse during preadolescence [21]. In addition, parents who abuse their children during adolescence are less likely to have been abused as children themselves compared with those parents who abused their children during preadolescence [21]. It is believed that the psychosocial effects of bodily injury manifest similarly in late childhood and adolescence.
RECOGNIZING WARNING SIGNS It is crucial that practitioners become familiar with the indica- tions of child abuse and neglect. These factors do not necessar- ily conclusively indicate the presence of abuse or neglect; rather, they are clues that require further interpretation and clinical investigation. Some parental risk indicators include [16]: • Recounting of events that do not conform either with the physical findings or the child’s physical and/or developmental capabilities • Inappropriate delay in bringing the child to a health facility • Unwillingness to provide information or the informa- tion provided is vague • History of family violence in the home • Parental misuse of substances and/or alcohol • Minimal knowledge or concern about the child’s devel- opment and care • Environmental stressors, such as poverty, single parent- hood, unemployment, or chronic illness in the family • Unwanted pregnancy • Early adolescent parent • Expression that the parent(s) wanted a baby in order to feel loved • Unrealistic expectations of the child • Use of excessive physical punishment • Healthcare service “shopping” • History of parent “losing control” or “hitting too hard” Child risk indicators include [16]: • Multiple school absences • Learning or developmental disabilities • History of multiple, unexplained illnesses, hospitaliza- tions, or accidents • Poor general appearance (e.g., fearful, poor hygiene, malnourished appearance, inappropriate clothing for weather conditions) • Stress-related symptoms, such as headaches or stomach- aches • Frozen watchfulness • Mental illness or symptoms, such as psychosis, depres- sion, anxiety, eating disorders, or panic attacks • Regression to wetting and soiling • Sexually explicit play • Excessive or out-of-the-ordinary clinging behavior • Difficulties with concentration • Disruptions in sleep patterns and/or nightmares
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