We all have a role to play in building strong communities in which families and children are valued and supported. It is in these kinds of communities that children are safest from abuse and neglect. Here are some things you can do as a concerned individual.

The Five R's
Prevent Child Abuse America has developed the following "Five R's," which can help individuals better understand the role they can play in child abuse prevention.

Raise the issue.
Call or write your candidates and elected officials to educate them about issues in your community and the need for child abuse prevention, intervention, and treatment programs.

Contact your local school district and faith community to encourage them to sponsor classes and support programs for new parents.

Reach out to kids and parents in your community.
Anything you do to support kids and parents in your family and extended community helps to reduce the likelihood of child abuse and neglect.

Be a good neighbor. Offer to baby-sit. Donate your children's used clothing, furniture, and toys for use by another family. Be kind and supportive, particularly to new parents and children.

Remember the risk factors.
Child abuse and neglect occur in all segments of our society, but the risk factors are greater in families where parents:

• Abuse alcohol or drugs
• Are isolated from their families or communities
• Have difficulty controlling their anger or stress
• Appear uninterested in the care, nourishment, or safety of their children
• Seem to be having serious economic, housing, or personal problems

Recognize the warning signs.
Some of the warning signs that a child might be abused or neglected include:

• Nervousness around adults
• Aggression toward adults or other children
• Inability to stay awake or to concentrate for extended periods
• Sudden, dramatic changes in personality or activities
• Acting out sexually or showing interest in sex that is not appropriate for his or her age
• Frequent or unexplained bruises or injuries
• Low self-esteem
• Poor hygiene

Report suspected abuse or neglect.
If you suspect abuse or neglect is occurring, report it—and keep reporting it—until something is done. Contact child protective services (in your local phone book) or your local police department.

Other Ways You Can Help

Build a support network by getting involved in your neighborhood.

• Develop friendly relationships with your neighbors and their children. Problems often seem less overwhelming when you have support nearby.
• Get involved in your child's school. Join the parent-teacher organization and attend school events.
• Talk to your friends and neighbors about child abuse and how to prevent it.

Learn how your community supports children and families.
The following programs may be offered through schools, healthcare clinics, social service agencies, or community- or faith-based organizations:

• Parent education programs teach parents about child development and parenting skills.
• Home-visiting programs provide social support, education, and crisis intervention to families at risk for abuse. (See Healthy Families America's Website.)
• Substance abuse treatment programs can help parents overcome problems with alcohol or other drugs.
• Well-baby programs provide health and education services to new parents.
• Childcare programs offer affordable childcare services. This may allow parents to maintain full-time jobs or stay in school while keeping their children safe.
• Respite care provides relief to families with a child or other family member who is ill or has a disability.
• Parent mentor programs match experienced, stable parents with parents at risk for abuse. Mentors provide support and model positive parenting skills.
• Family support centers offer an array of preventive support services, including many of those listed above, as well as referral to other community services. (See Family Support America's Website.)
• Parent support groups offer a place for parents to meet and discuss parenting issues, exchange ideas, and offer support. (See Circle of Parents's Website and Parents Anonymous® Inc.'s Website.)

Take part in community prevention efforts.

• Help local organizations distribute educational materials on parenting and child abuse prevention.
• Encourage local schools or other community organizations to provide parenting education.
• Offer to speak to the media and other groups about your own experiences as a parent. Parents Anonymous® Inc. has a resource guide, Media Guide for Parent Leaders, that may be helpful. (See Parents Anonymous® Inc.'s Website.)
• Organize a fundraiser or a food drive to support an organization that helps families in your community.
• Offer to teach a seminar on strengthening marriages. Talk with others at community events (neighborhood fairs, back-to-school nights, holiday festivals) about why it is important to have a healthy marriage and how they can strengthen marriages in their communities.
• Provide friendship and guidance to parents and children who need your help by volunteering for programs such as Befriend-a-Child or Court Appointed Special Advocates (CASA).
• Contact your elected officials and ask them to support funding for prevention efforts and policies that support children and families.
• Make a donation to an organization that works to prevent child abuse. You can donate money, or give clothing, food, or toys to a social service agency that helps families in your community.
• Start or join a community coalition to prevent child abuse and neglect.

 Recognizing Child Abuse and Neglect: Signs and Symptoms

Year Published: 09/2003

Introduction

The first step in helping abused or neglected children is learning to recognize the signs of child abuse and neglect. The presence of a single sign does not prove child abuse is occurring in a family; however, when these signs appear repeatedly or in combination you should take a closer look at the situation and consider the possibility of child abuse.

If you do suspect a child is being harmed, reporting your suspicions may protect the child and get help for the family. Contact your local child protective services agency or police department.

Recognizing Child Abuse

The following signs may signal the presence of child abuse or neglect.

The Child:

• Shows sudden changes in behavior or school performance.
• Has not received help for physical or medical problems brought to the parents' attention.
• Has learning problems (or difficulty concentrating) that cannot be attributed to specific physical or psychological causes.
• Is always watchful, as though preparing for something bad to happen.
• Lacks adult supervision.
• Is overly compliant, passive, or withdrawn.
• Comes to school or other activities early, stays late, and does not want to go home.

The Parent:

• Shows little concern for the child.
• Denies the existence of—or blames the child for—the child's problems in school or at home.
• Asks teachers or other caretakers to use harsh physical discipline if the child misbehaves.
• Sees the child as entirely bad, worthless, or burdensome.
• Demands a level of physical or academic performance the child cannot achieve.
• Looks primarily to the child for care, attention, and satisfaction of emotional needs.

The Parent and Child:

• Rarely touch or look at each other.
• Consider their relationship entirely negative.
• State that they do not like each other.

Types of Abuse

The following are some signs often associated with particular types of child abuse and neglect: physical abuse, neglect, sexual abuse, and emotional abuse. It is important to note, however, these types of abuse are more typically found in combination than alone. A physically abused child, for example, is often emotionally abused as well, and a sexually abused child also may be neglected.

Signs of Physical Abuse

Consider the possibility of physical abuse when the child:

• Has unexplained burns, bites, bruises, broken bones, or black eyes.
• Has fading bruises or other marks noticeable after an absence from school.
• Seems frightened of the parents and protests or cries when it is time to go home.
• Shrinks at the approach of adults.
• Reports injury by a parent or another adult caregiver.

Consider the possibility of physical abuse when the parent or other adult caregiver:

• Offers conflicting, unconvincing, or no explanation for the child's injury.
• Describes the child as "evil," or in some other very negative way.
• Uses harsh physical discipline with the child.
• Has a history of abuse as a child.

Signs of Neglect

Consider the possibility of neglect when the child:

• Is frequently absent from school.
• Begs or steals food or money.
• Lacks needed medical or dental care, immunizations, or glasses.
• Is consistently dirty and has severe body odor.
• Lacks sufficient clothing for the weather.
• Abuses alcohol or other drugs.
• States that there is no one at home to provide care.

Consider the possibility of neglect when the parent or other adult caregiver:

• Appears to be indifferent to the child.
• Seems apathetic or depressed.
• Behaves irrationally or in a bizarre manner.
• Is abusing alcohol or other drugs.

Signs of Sexual Abuse

Consider the possibility of sexual abuse when the child:

• Has difficulty walking or sitting.
• Suddenly refuses to change for gym or to participate in physical activities.
• Reports nightmares or bedwetting.
• Experiences a sudden change in appetite.
• Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior.
• Becomes pregnant or contracts a venereal disease, particularly if under age 14.
• Runs away.
• Reports sexual abuse by a parent or another adult caregiver.

Consider the possibility of sexual abuse when the parent or other adult caregiver:

• Is unduly protective of the child or severely limits the child's contact with other children, especially of the opposite sex.
• Is secretive and isolated.
• Is jealous or controlling with family members.

Signs of Emotional Maltreatment

Consider the possibility of emotional maltreatment when the child:

• Shows extremes in behavior, such as overly compliant or demanding behavior, extreme passivity, or aggression.
• Is either inappropriately adult (parenting other children, for example) or inappropriately infantile (frequently rocking or head-banging, for example).
• Is delayed in physical or emotional development.
• Has attempted suicide.
• Reports a lack of attachment to the parent.

Consider the possibility of emotional maltreatment when the parent or other adult caregiver:

• Constantly blames, belittles, or berates the child.
• Is unconcerned about the child and refuses to consider offers of help for the child's problems.
• Overtly rejects the child.

This fact sheet was adapted, with permission, from Recognizing Child Abuse: What Parents Should Know. Prevent Child Abuse America. © 2003

This fact sheet is an excerpt from Emerging Practices in the Prevention of Child Abuse and Neglect, (2003) U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau, Office on Child Abuse and Neglect. The findings and conclusions presented in this fact sheet do not necessarily represent the official positions or policies of the Children's Bureau's Office on Child Abuse and Neglect.

Risk Factors

While there are varying schools of thought on the origins of maltreatment, most theories of child maltreatment recognize that the root causes can be organized into a framework of four principal systems: (1) the child, (2) the family, (3) the community, and (4) the society. Though children are not responsible for the abuse inflicted upon them, certain child characteristics have been found to increase the risk or potential for maltreatment. Children with disabilities or mental retardation, for example, are significantly more likely to be abused (Crosse, Kaye, & Ratnofsky, 1993; Schilling & Schinke, 1984). Evidence also suggests that age and gender are predictive of maltreatment risk. Younger children are more likely to be neglected, while the risk for sexual abuse increases with age (Mraovick & Wilson, 1999). Female children and adolescents are significantly more likely than males to suffer sexual abuse.

Important characteristics of the family are linked with child maltreatment. Families in which there is substance abuse are more likely to experience abuse or are at a higher risk of abuse (Ammerman et al., 1999; Besinger et al., 1999; U.S. Department of Health and Human Services, 1993). But, identifying families in which substance abuse is present can be difficult. The Child Welfare League of America (2001) recently found that substance abuse is present in 40 to 80 percent of families in which children are abuse victims. Recent studies also have established a link between having a history of childhood abuse and becoming a victimizer later in life, including Clarke et al. (1999), confirming some of the earliest work in the field. DiLillo, Tremblay, and Peterson (2000) found that childhood sexual abuse increased the risk of perpetrating physical abuse on children as adults. Domestic violence and lack of parenting or communication skills also increase the risks of maltreatment to children.

Factors related to the community and the larger society also are linked with child maltreatment. Poverty, for example, has been linked with maltreatment, particularly neglect, in each of the national incidence studies (Sedlak & Broadhurst, 1996), and has been associated with child neglect by Black (2000) and found to be a strong predictor of substantiated child maltreatment by Lee and Goerge (1999). Bishop and Leadbeater (1999) found that abusive mothers reported fewer friends in their social support networks, less contact with friends, and lower ratings of quality support received from friends. Violence and unemployment are other community-level variables that have been found to be associated with child maltreatment. Perhaps the least understood and studied level of child maltreatment is that of societal factors. Ecological theories postulate that factors such as the narrow legal definitions of child maltreatment, the social acceptance of violence (as evidenced by video games, television and films, and music lyrics), and political or religious views that value noninterference in families above all may be associated with child maltreatment (Tzeng, Jackson, & Karlson, 1991).

Protective Factors

Researchers, practitioners, and policy makers are now increasingly thinking about protective factors within children and families that can reduce risks, build family capacity, and foster resilience. In 1987, case studies of three victims of child maltreatment began to shed light on the dynamics of survival in high-risk settings. Resilience in maltreated children was found to be related to personal characteristics that included a child's ability to: recognize danger and adapt, distance oneself from intense feelings, create relationships that are crucial for support, and project oneself into a time and place in the future in which the perpetrator is no longer present (Mrazek & Mrazek, 1987).

Since then, researchers have continued to explore why certain children with risk factors become victims and other children with the same factors do not. What are the factors that appear to protect children from the risks of maltreatment? In a recent overview by the Family Support Network, factors that may protect children from maltreatment include child factors, parent and family factors, social and environmental factors. Child factors that may protect children include good health, an above-average intelligence, hobbies or interests, good peer relationships, an easy temperament, a positive disposition, an active coping style, positive self-esteem, good social skills, an internal locus of control, and a balance between seeking help and autonomy.

Parent and family protective factors that may protect children include secure attachment with children, parental reconciliation with their own childhood history of abuse, supportive family environment, household rules and monitoring of the child, extended family support, stable relationship with parents, family expectations of pro-social behavior, and high parental education. Social and environmental risk factors that may protect children include middle to high socioeconomic status, access to health care and social services, consistent parental employment, adequate housing, family participation in a religious faith, good schools, and supportive adults outside the family who serve as role models or mentors (Family Support Network, 2002). Some recent studies have found that families with two married parents encounter more stable home environments, fewer years in poverty, and diminished material hardship (Lerman, 2002).

The following two pages summarize common risk and protective factors for child abuse and neglect.

Common Risk Factors for Child Abuse and Neglect*

Child Risk Factors

Premature birth, birth anomalies, low birth weight, exposure to toxins in utero
Temperament: difficult or slow to warm up
Physical/cognitive/emotional disability, chronic or serious illness
Childhood trauma
Anti-social peer group
Age
Child aggression, behavior problems, attention deficits

Parental/Family Risk Factors

Personality Factors
External locus of control
Poor impulse control
Depression/anxiety
Low tolerance for frustration
Feelings of insecurity
Lack of trust
Insecure attachment with own parents
Childhood history of abuse
High parental conflict, domestic violence
Family structure - single parent with lack of support, high number of children in household
Social isolation, lack of support
Parental psychopathology
Substance abuse
Separation/divorce, especially high conflict divorce
Age
High general stress level
Poor parent-child interaction, negative attitudes and attributions about child's behavior
Inaccurate knowledge and expectations about child development

Social/Environmental Risk Factors

Low socioeconomic status
Stressful life events
Lack of access to medical care, health insurance, adequate child care, and social services
Parental unemployment; homelessness
Social isolation/lack of social support
Exposure to racism/discrimination
Poor schools
Exposure to environmental toxins
Dangerous/violent neighborhood
Community violence

*Please note that this is not an all-inclusive or exhaustive list. These factors do not imply causality and should not be interpreted as such. back

Common Protective Factors for Child Abuse and Neglect*

Child Protective Factors

Good health, history of adequate development
Above-average intelligence
Hobbies and interests
Good peer relationships
Personality factors
Easy temperament
Positive disposition
Active coping style
Positive self-esteem
Good social skills
Internal locus of control
Balance between help seeking and autonomy

Parental/Family Protective Factors

Secure attachment; positive and warm parent-child relationship
Supportive family environment
Household rules/structure; parental monitoring of child
Extended family support and involvement, including caregiving help
Stable relationship with parents
Parents have a model of competence and good coping skills
Family expectations of pro-social behavior
High parental education

Social/Environmental Protective Factors

Mid to high socioeconomic status
Access to health care and social services
Consistent parental employment
Adequate housing
Family religious faith participation
Good schools
Supportive adults outside of family who serve as role models/mentors to child

*Please note that this is not an all-inclusive or exhaustive list. These factors do not imply causality and should not be interpreted as such. back

References

Ammerman, R., Kolko, D., Kirisci, L., Blackson, T., & Dawes, M. (1999). Child abuse potential in parents with histories of substance abuse disorder. Child Abuse and Neglect, 23, 1225-1238.

Besinger, B., Garland, A., Litrownik, A., & Landsverk, J. (1999). Caregiver substance abuse among maltreated children placed in out-of-home care. Child Welfare, 78(2), 221-239.

Bishop, S., & Leadbeater, B. (1999). Maternal social support patterns and child maltreatment: Comparison of maltreating and nonmaltreating mothers. American Journal of Orthopsychiatry, 69, 172-181.

Black, D. A., Heyman, R. E., & Smith Slep, A. M. (2001). Risk factors for child physical abuse. Aggression and Violent Behavior, 6, 121-188.

Black, M. (2000). The roots of child neglect. In R.M. Reece (Ed.), Treatment of child abuse: Common mental health, medical, and legal practitioners. Baltimore, MD: Johns Hopkins University Press.

Chalk, R., & King, R. A. (1998). Violence in families: Assessing prevention and treatment programs. Washington, DC: National Academy Press, 41-50.

Child Welfare League of America. (2001). Alcohol, other drugs, & child welfare. 2001/0-87868-839-0/#8390. Washington, DC: CWLA.

Clarke, J., Stein, M., Sobota, M., Marisi, M., & Hanna, L. (1999). Victims as victimizers: Physical aggression by persons with a history of childhood abuse. Archives of Internal Medicine, 159, 1920-1924.

Crosse, S., Kaye, E., & Ratnofsky, A. (1993). A report on the maltreatment of children with disabilities. Washington, DC: National Clearinghouse on Child Abuse and Neglect Information.

Davies, D. (1999). Child Development: A Practitioner's Guide. New York, NY: Guilford Press.

DiLillo, D., Tremblay, G., & Peterson, L. (2000). Maternal anger. Child Abuse and Neglect, 24(6), 767-779.

Family Support Network. (2002). Child abuse and neglect. Available: http://www.familysupport.org/Abuse.cfm.

Harrington, D., & Dubowitz, H. (1999). Preventing child maltreatment. In R. L. Hampton (Ed.), Family violence: 2nd edition. Prevention and treatment. Thousand Oaks, CA: Sage Publications.

Heyman, R. E., & Smith Slep, A. M. (2001). Risk factors for family violence: Introduction to the special series. Aggression and Violent Behavior, 6, 115-119.

Lee, B., & Goerge, R. (1999). Poverty, early childbearing, and child maltreatment: A multinomial analysis. Child and Youth Services Review, 21(9-10), 755-780.

Lerman, R. (2002). Wedding bells ring in stability and economic gains for mothers and children. Available: http://www.urban.org/url.cfm?ID=900554

Mraovick, L., & Wilson, J. (1999). Patterns of child abuse and neglect associated with chronological age of children living in a midwestern county. Child Abuse and Neglect, 23(9), 899-903.

Mrazek, P., & Mrazek, D. (1987). Resilience in child maltreatment victims: A conceptual exploration. Child Abuse and Neglect, 11, 357-366.

National Research Council. (1993). Understanding child abuse and neglect. Washington, DC: National Academy Press.

Schilling, R., & Schinke, S. (1984). Personal coping and social support for parents of handicapped children. Child and Youth Services Review, 6, 195-206.

Schumaker, J. A., Smith Slep, A. M., & Heyman, R. E. (2001). Risk factors for child neglect. Aggression and Violent Behavior, 6, 231-254.

Sedlak, A., & Broadhurst, D. (1996). Third National Incidence Study of child abuse and neglect: Final report. Washington, DC: U.S. Government Printing Office.

Tzeng, O., Jackson, J., & Karlson, H. (1991). Theories of child abuse and neglect: Differential perspectives, summaries, and evaluations. New York: Praeger Publishers.

U.S. Department of Health and Human Services. (1993). Study of child maltreatment in alcohol abusing families. Washington, DC: National Center on Child Abuse and Neglect.