• Frequently Asked Questions: Detecting Child Abuse

    The Child Abuse Team at Cincinnati Children’s provides the following frequently asked questions (FAQs) and answers.

  • If your child tells you of abuse, listen to what he or she has to say and report your concerns to the child welfare agency. Younger children may show signs of abuse in the form of injuries that can’t be easily explained as coming from normal childhood accidents.

    Some types of injuries are suspicious or indicative of abuse. These include:

    • Injuries that occur in a pattern or show the markings of the implement used to inflict the injuries −  belts, buckles, cords, cigarette burns
    • Immersion burns, in which the child has been dipped in scalding water, which are indicated by sharply defined areas of redness
    • Bruises on children who don’t walk yet
    • Unexplained fractures, lacerations or abrasions
    • Evidence of delayed or inappropriate treatment for injuries

    Some behaviors, or behavior changes, may also stem from physical abuse. These include: 

    • Withdrawal
    • Self-destructive behavior
    • Aggression
    • Fear of being at home or running away from home
    • Bizarre, inconsistent or improbable explanations of injuries
    • Wariness of adult contact and apprehensiveness with others

    Please call the police or child welfare agency in the jurisdiction where you live. Talk about your concerns, and someone may be able to help you clarify what may be happening.

    All children who are physically active get bumps and bruises, which in themselves are not evidence of child abuse.

    Physicians look for a plausible history to explain bruises and a pattern of bruises consistent with a child’s normal activity. Infants, because they don’t walk and are not very active, are not prone to bruising. Toddlers, however, typically have bruises on their shins and foreheads from running and falling into things − but they don’t normally have bruises in protected areas like the inside thigh. The severity and the number of bruises are other factors physicians observe.

    If a child truly does bruise more easily than normal, that could be a sign of a serious problem that requires medical attention. Clotting disorders and some connective tissue diseases are among the conditions that may cause a child to bruise easily.

    When a child masturbates in public places and doesn’t respond to limits placed on the behavior by caregivers − that may be a sign that the child is doing it as a way to contain anxiety over abuse. Ordinarily, parents or caregivers can place limits on the behavior by explaining to the child that masturbation should be private.

    Pay attention to what your child is saying and doing and the kinds of fears he or she expresses. If your child acts in a different manner after returning from an overnight trip, ask if everything is OK.

    Major behavior changes also can signify abuse. These may include:

    • New fears of people or places
    • Withdrawal
    • Sexual play beyond what might be considered normal for the child’s age
    • Fear that something is wrong with the genital area
    • Regression or baby-like behavior
    • Sleep disturbances or nightmares

    The most important thing is to have a strong enough relationship with your children that they will tell you about problems.

    Rarely. Most stories about abuse that never occurred come from adults. Very young children, in particular, are unlikely to make up stories, because they haven’t had any experiences that would allow them to fabricate them. A skilled interviewer experienced with child sexual abuse should be brought in to talk with the child immediately upon a report being made.

    This is a concern often in the back of parents’ minds, because they’ve heard stories of how child abuse is frequently seen in the emergency room. When doctors and nurses start asking parents about the specifics of how an injury occurred,, parents sometimes feel they’re being interrogated.

    Parents should keep in mind that physicians and nurses need to be looking for child abuse, because they’ll miss opportunities to protect children if they don’t. They also need to have a thorough understanding of how injuries occur in order to provide the best care. Parents who bring their children in for accidental injuries should not hesitate to answer questions and shouldn’t feel they’re being singled out.

    Genital warts and herpes are conditions that are frequently sexually transmitted, but sexual contact is only one of the ways children can get these infections. Both conditions can also be spread through non-sexual touching. Your child may have a wart or herpes infection elsewhere on her body and spread the infection to the genitalia or rectum.

    When children are diagnosed with an infection that can be transmitted sexually, a parent and physician should investigate for possible sexual abuse. A physician or social worker will likely interview your child to see if he provides a history of abuse and perform an examination and tests to see if he has any other physical indications of sexual abuse, such as the presence of other sexually transmitted diseases or physical injuries.

    Barring other indications, physicians at Cincinnati Children’s do not report children as possible victims of abuse to child welfare or law enforcement agencies simply on the basis of genital or rectal warts or herpes.

    In many cases, even when vaginal penetration has occurred, a medical examination will not detect it. 

    The idea that a girl’s hymen is always broken if penetration occurs is a myth. Prior to puberty, a girl’s vaginal opening is quite small. Her hymen is tissue that partially covers the vaginal opening. Penetration beyond the hymen and into the vagina may cause damage that a physician will observe. Contact around and to the hymen, however, may cause pain to the child without producing noticeable injury. The child may describe this degree of contact as penetration, and in some states it constitutes legal penetration. After the onset of puberty, the opening of the vagina becomes enlarged. Penetration beyond the hymen then may occur more often without any tearing or signs of injury to the hymen.

    Most straddle injuries do not result in injury to the hymen.

    Ordinary, every-day people. Your neighbors. Your extended family. People you might never suspect.

    Sexual abuse is almost always done by someone known to the child. Physical abuse is almost always committed by a family member or a surrogate parent.

    People under stress, who are frustrated or angry, are more likely to lash out at children. In the case of babies who are shaken, the abuser sometimes doesn’t understand the damage that can be done.

    Many are, but not all. Studies estimate 30 percent to 60 percent of abusers were themselves abused. But abuse is only part of the story. Adults who abuse children physically may not have been abused themselves, but they likely had little nurturing or had poor role models. Such a history may spawn adults with poor self-images and poor parenting skills. These are ingredients in the makeup of an abuser. None of these factors excuses the abuse, but it may hold the key to helping the abuser.