Child Abuse and Maltreatment

Spinal Cord Trauma

  • May cause damage to motor nerves, leading to paralysis.
  • Other signs include loss of consciousness, seizures, numbness, or increased drowsiness.
  • Unconsciousness may also result from medication or poison.

Head Injuries

  • Hair pulling can cause bald patches.
  • Medical examination is necessary to determine the extent and rule out other causes.

Subdural Hematomas

  • Accumulation of blood between the brain and its outermost covering.
  • Acute form: Direct injury to the brain.
  • Chronic form: Gradual blood accumulation causing headaches, stupor, and muscular weakness, appearing weeks after the injury.
  • Sharp blows or severe shaking can cause it.
  • In infants, coma or seizure may be the only signs.

Abdominal Injuries

  • Signs include recurrent vomiting, swelling, and tenderness.
  • Trauma may injure organs like the liver and kidney.
  • Forceful blows may cause bruises, ruptures, hemorrhage, shock, or death.

Immediate Considerations for Various Injuries

  • Detailed physical examination findings.
  • Color photos of visible trauma if abuse is suspected.
  • Discussion with medical professionals on the nature and cause of the injury; identify professionals by name, title, and address.
  • Interviews with the child and family regarding the injury's history and consistency with the injury type, location, child's age, and condition; use direct quotes for documentation.
  • Extent of parental control at the time of injury and events leading to it.

Lacerations / Bruises / Welts

  • Lacerations: Jagged cuts or tears in the skin.
  • Multiple skin injuries in different healing stages may indicate abuse.
  • Medical examination is needed to determine the nature and extent of these injuries.
  • Scars or disfigurements may resemble the instrument used (e.g., strap marks, belt buckles).
  • Welts: Raised ridges on the skin, often in the lower back, from blows or slashes.

Bite Marks

  • Human bite marks: Distinctive crescent-shaped lines.
  • Child's bite: Larger arch of the crescent than an adult's.
  • Human bites compress flesh causing bruises; animal bites tear flesh.

Bruises

  • Caused by bleeding beneath the skin.
  • Suspicious signs: Old and new bruises, facial bruises, back of legs bruises.
  • Medical tests needed to rule out bleeding disorders.
  • Consider bruises as a normal occurrence in children.

Swelling / Dislocations / Sprains

  • Swelling where bones join, tenderness at joints indicate skeletal injuries without fracture.
  • Limited walking ability due to leg injuries.
  • Dislocations or sprains can result from pulling, jerking, or twisting limbs.

Choking / Twisting / Shaking

  • Twisting and shaking can cause injuries.
  • Twisting ear can cause earlobe injuries.
  • Genitals may be injured by twisting in sexual abuse cases.
  • Repeated or forceful twisting of limbs can result in spiral bone fractures.
  • Violent shaking can cause brain or spinal column injury.
  • Choking: Compression of the windpipe stopping breathing.
  • Suffocation: Foreign objects lodged in the windpipe.

Burns / Scalding

  • First-degree: Redness.
  • Second-degree: Blistering.
  • Third-degree: Destruction of skin tissue.
  • Abuse signs: Glove or stocking burns, doughnut burns, geometric shapes, scald burns on the back, buttocks, or genital areas, rope burns, cigarette burns in multiple locations, and burns on areas typically protected by clothing.
  • Scaldings may result from an act or an omission of parent such as failure to supervise the child.

Poisoning / Noxious Substances

  • Various household and medicinal items can cause serious harm if ingested.
  • Factors in evaluating abuse:
    • Child's age
    • Substance location and storage
    • Parental steps to prevent access
    • Actions taken for care
    • Previous incidents
  • Intentional poisoning should be considered for infants.

Excessive Corporal Punishment

  • Maltreatment if it goes beyond what is objectively reasonable.
  • Critical factors to consider:
    • Child's age, sex, condition, and understanding
    • Nature and means of punishment
    • Seriousness of injury or risk
    • Appropriateness of the means
    • Purpose, duration, and character of the punishment

Parent Drug / Alcohol Misuse

  • Can result in harm or imminent danger to a child.
  • Determine if the parent has lost self-control and is unable to care for the child.
  • Participation in a rehabilitative program is irrelevant if the child is still at risk.
  • Positive toxicology in newborns requires thorough investigation.
  • SCR should not register a report in cases of positive toxicology of an infant if the birthing parent is compliant with a drug treatment program or is under the care and supervision of a doctor and is using the drugs as prescribed and is demonstrating an ability to care for the infant. Also, the SCR should not register a report if the only reported concern is that an infant tests positive for the presence of cannabis or alcohol without a demonstrated effect on the infant.

Child's Drug / Alcohol Use

  • Harmful to mental and physical development.
  • Considered abuse/maltreatment if:
    • Quantity causes harm or imminent danger
    • Parental failure to prevent or encouraging use

Lack of Medical Care / Medical Neglect

  • Failure to provide adequate medical, dental, optometrical or surgical care.
  • Includes seeking treatment, following prescriptions, and obtaining preventive care.
  • Considers seriousness of the condition, parental awareness, medical opinion, and financial ability.
  • Acceptable course of treatment must be provided.

Educational Neglect

  • Unexcused absence from full-time instruction.
  • Course of study doesn't meet state requirements.
  • Parental failure to ensure school enrollment or attendance.
  • School doesn't notify parent regarding unexcused absences.
  • Parent's failure to cooperate in obtaining a special educational plan.
  • The child's education must be impaired.

Emotional Neglect

  • Substantially diminished psychological or intellectual functioning in the child.
  • Attributable to the parent's conduct.
  • Factors include:
    • Harmful parental behavior
    • Observable effects on the child
    • Substantial impairment to the child’s ability to function as a normal human being.
  • Assessment should be performed by a qualified professional.

Sexual Abuse

  • Sex offense committed by a parent or legal guardian against a child under 18.
  • Includes rape, sodomy, incest, and sexual performance.
  • A person is deemed legally incapable of consent if less than 17 years, or mentally disabled, or mentally incapacitated, or physically helpless.
  • Considers touching intimate parts for sexual gratification, sexual intercourse, oral or anal conduct, sexual activity with others, and profiting from a child involved in prostitution.

Allowing Sex Abuse to Occur

  • It is a form of sex abuse for child protective purposes for a subject to allow any of the crimes to be committed.
  • There must be underlying sex abuse.

Malnutrition / Failure-to-Thrive

  • Malnutrition: Failure to receive adequate nourishment.
  • Non-organic failure-to-thrive: Infant's weight, height, and motor development fall significantly below age-appropriate ranges with no medical cause.
  • Requires physician evaluation, family history, physical exam, bone x-rays, and lab tests.

Inadequate Food / Clothing / Shelter

  • Actual failure to supply adequate food, clothing, or shelter, despite financial ability.
  • Food: Nutrients essential for growth.
  • Clothing: Basic, clean items appropriate for the weather.
  • Shelter: Safe, sanitary, heated housing.

Inadequate Guardianship

  • Fails to meet minimum care standard.
  • Results in physical or developmental harm or imminent danger.
  • Includes continually allowing a child to remain away from home for extended periods of time without knowledge of the child's whereabouts.

Lack of Supervision

  • Child alone or not competently attended to, leading to harm or exposure to hazards.
  • Varies with the age and developmental stage of the child.

Abandonment

  • Shows intent to forgo parental rights and obligations.
  • Consider expectations for duration, parental failure to return, ability to return, and the parent’s identity and whereabouts.

Dead on Arrival (DOA) / Fatality

  • Actions or inactions contributed to the death of the child.

Other

  • Court-ordered investigations.
  • A Person legally responsible for a child is a registered, convicted or recently arrested child sex offender

Standards of Evidence

  • Differ with each child protective process stage.

Criminal Justice System

  • A criminal offense is conduct, by act or omission, punishable by imprisonment or fine.

Child Fatality Investigations

  • Fatality report checklists
  • Investigating sleep related fatality and injury CPS reports