Course Background & Resources

These characteristics have a greater likelihood of existing in situations where a child is suspected of being abused or maltreated, but may not be indicative of every situation. They should be seen as clues or red flags in the deliberation of suspected cases of abuse or maltreatment. The more characteristics that exist in the situation you are evaluating, the greater the likelihood that abuse or maltreatment may have taken place. If there are only one or two characteristics that exist in the situation, further careful assessment may be warranted.

• Past history of having been abused or neglected themselves
• Lack of friendships or emotional support
• Community isolation
• Inability to ask for and receive necessary help and support
• Avoidance of social contact, even with family
• Lack of trust of people
• Lack of self-esteem, feelings of worthlessness
• Relationship problems of caretaker, including partner abuse
• Physical or mental health problems, irrational behavior
• Life crises such as financial problems, unemployment, low wages, homelessness
• Alcohol/substance abuse
• Adolescent stage of development
• Seem unconcerned about the child
• Takes an unusual amount of time to obtain medical care for the child
• Gives different explanations for the same injury
• Disciplines the child too harshly considering their age or what they did wrong
• Tries to conceal the child’s injury, or takes the child to a different doctor or hospital for each injury
• Has poor impulse control
• Has a disorganized, upsetting home life
• Is apathetic, and feels nothing will change
• Has a long-term chronic illness or limited intellectual capacity
• Treats children in the family unequally, or inconsistently
• May seem not to care about the child’s problems, or may be very protective or jealous of the child
• Blames or belittles the child, appears to be cold or rejecting
• Unrealistic expectations of child to meet caretaker’s emotional needs
• Absence of nurturing child-rearing skills
• Violent/corporal punishment methods of discipline accepted within the caretaker’s culture of child-rearing
• Acceptance of violence as normal means of personal interaction
• Delay or failure in seeking health care for child’s regular immunizations, illness or injury
• Views child as bad, evil, different, etc.

Key features in identifying injuries that have been caused due to physical abuse are:

• Their placement
• The explanation provided for them
• The frequency and/or sequencing of such injuries

Injuries in non-accidental injury sites should be seen as suspicious. Injuries that are unexplained or are inconsistent with the parent or caretaker’s explanation and/or the developmental stage of the child are also red flags. Injuries that appear to be in various stages of healing, or are numerous but inconsistent with the explanation provided should also be viewed with concern.

Additionally, caregivers should not strike children with objects such as belts, switches, or other objects. If this is suspected it should be called in to the SCR, whether an injury is visible or not.

Physical Indicators

• Bruises, welts and bite marks in various stages of healing regularly appearing after an absence, weekend or vacation on several different areas in non-accidental injury sites such as face, lips, mouth, both eyes or cheeks, neck, wrists, ankles, torso, back, buttocks or thighs clustered or in the pattern of a purposeful instrument such as a belt buckle or electric cord that mimic grab marks on arms or shoulders that provide evidence of a human bite (wide tooth imprint, compressed flesh)
• Lacerations or abrasions to mouth, lips, gums, eyes, external genitalia or on back, arms, legs or torso; burns patterned like an electric burner, an iron or end of cigar/cigarette in non-accidental injury sites such as soles, palms, back or buttocks resembling rope burns on arms, legs, neck or torso resembling immersions by scalding water (sock-like, glove-like, or doughnut-shaped on buttocks or genitalia, purposefully dunked)
• Fractures to skull, nose or other facial structures in various stages of healing multiple or spiral in nature accidentally discovered during a regular exam
• Skeletal injuries accompanied by other injuries
• Head Injuries, subdural hematoma (due to severe hitting or shaking), retinal hemorrhage or detachment (due to shaking), whiplash shaken infant syndrome, injuries to the eye, jaw, nose, teeth or frenulum or absence of hair and/or hemorrhaging beneath the scalp due to vigorous hair pulling
• Munchausen Syndrome by Proxy (MSP) symptoms that suggest parentally induced or fabricated illness (e.g., repeatedly causing a child to ingest quantities of laxatives sufficient to cause diarrhea, dehydration and hospitalization)

Behavioral Indicators

• Wary of contact with parents or other adults
• Apprehensive when other children cry
• Exhibits behavioral extremes, such as aggression and then withdrawal
• Afraid to go home, frightened of caretaker
• Frequent incidents of running away
• Reports injury by caretaker or parents
• Displays symptoms of habit disorders, such as self-injury, neurotic reactions (obsessive, compulsive, phobic, hypochondria)
• Attempts to conceal injury with long sleeves, etc.
• Manifests low self-esteem
• Attempts suicide
• Seeks affection from any adult

Physical Indicators

• Failure to thrive (physically or emotionally)
• Positive drug toxicology, especially in newborns
• Lags in physical development
• Consistent hunger, poor hygiene and inappropriate dress for the weather
• Speech disorders
• Consistent lack of supervision for extended periods, or in dangerous situations
• Unattended physical problems or medical needs
• Chronic truancy
• Abandonment

Behavioral Indicators

• Begging or stealing food
• Extended stays at school (arriving early or staying late)
• Constant fatigue, listlessness or falling asleep in class
• Alcohol or drug abuse
• Delinquency
• States there is no caretaker
• States that domestic violence or intimate partner abuse is going on in or outside of the home
• Runaway behavior
• Habit disorders such as sucking, biting, rocking, etc.
• Conduct disorders such as antisocial behavior, destructive behavior, etc.
• Neurotic traits such as sleep disorders, inhibition of play
• Psychoneurotic behaviors such as obsessions, compulsions, phobias or hypochondriasis
• Exhibits behavioral extremes (aggressive, demanding, compliant, passive)
• Overly adaptive behavior, such as being inappropriately adult-like or infant-like
• Mental or emotional developmental lags
• Attempts of suicide or gestures, self-mutilation

Most cases of sexual abuse do not present apparent physical indicators, and so identification can be quite difficult. In addition, many child victims of sexual abuse are extremely reluctant to report abuse, even to a very trusted adult or friend, for legitimate fear of retribution and/or worse abuse. To further complicate these concerns, it is true that the vast majority of perpetrators are family members or friends of the child and his or her family, making disclosure of the abuse very difficult for the child. Victims of sexual abuse often experience the fear of betraying a loved one, and possibly losing their affections if they report. They also fear the overwhelming anticipated shame and guilt that it is thought disclosure will cause, and fear being themselves blamed for the abuse.

While research suggests that few victims fabricate incidents of child sexual abuse, it is true that children may retract the disclosure as they experience pressure from family and/or friends. Many of them then choose to continue to live in devastating isolation with their secret. Most perpetrators of child sexual abuse know their victims well, as they are often trusted family members who have easy access to the child. It is not a unique problem of a certain class, race or geographic area. There is no clear and distinct typical profile of a child molester, or victim of sexual abuse. Do not make assumptions based on social position or reputation that someone might not be a child molester.

In NY State a child under the age of 17 cannot consent to any sexual activity. If a minor child is engaging in sexual activity with a much older child, or an adult, it is considered sexual abuse and should be reported to the SCR. If a caregiver knows about the sexual activity and doesn’t try to stop it, or allows the activity through their inadequate guardianship, this should be reported to the SCR as well. If the abuse is being perpetrated by someone not responsible for the care of the child, such as a coach, teacher, neighbor or babysitter, this may be reported to law enforcement as well through a law enforcement referral through the SCR, or by calling the police directly.

Physical Indicators

• Difficulty walking or sitting
• Pain, itching, bruises or bleeding in genital or anal area
• Torn, stained or bloody underclothing
• Bruises to the hard or soft palate
• Presence of sexually transmitted diseases
• Pregnancy, especially in early adolescent years
• Painful discharge of urine and/or repeated urinary infections
• Foreign bodies in vagina or rectum

Behavioral Indicators

• Unwilling to change for gym or participate in gym class
• Withdrawal, fantasy or infantile behavior
• Bizarre, sophisticated or unusual sexual behavior or knowledge
• Seductive or promiscuous behavior
• Poor peer relationships
• Alcohol or drug abuse
• Delinquency
• Reports assault by caretaker
• Runaway behavior
• Prostitution
• Forcing sexual acts on other children
• Extreme fear of closeness or being physically touched
• Truancy
• Manifestations of low self-esteem, general fearfulness
• Regressive behaviors such as bed wetting, rocking, thumb sucking or acting much younger than their age.
• Self-injurious behaviors, including suicide attempts

Under New York State Social Services Law (Section 412), an abused child is a child less than 18 years of age whose parent or another person legally responsible for his or her care:

• Inflicts or allows to be inflicted upon such child physical injury by other than accidental means, and such action causes or creates a substantial risk of death or serious or protracted disfigurement, impairment of physical or emotional health, or impairment of the function of any bodily organ
• Creates or allows to be created a substantial risk of physical injury to such a child by other than accidental means, and which would be likely to cause death or serious or protracted disfigurement, or protracted impairment of physical or emotional health, or protracted loss or impairment of the function of any bodily organ
• Commits a sexual offense or allows, permits or encourages such child to engage in any sex offense, as defined in Section 130 of the Penal Law such as sexual misconduct, rape, criminal sexual act, forcible touching, persistent sexual abuse, sexual abuse, aggravated sexual abuse, female genital mutilation or facilitating a sex offense with a controlled substance
• Commits any of the acts described in section 255.25 of the Penal Law (such as incest)
• Allows such child to engage in acts or conduct described in Article 263 of the Penal Law such as use of child in a sexual performance, promoting an obscene sexual performance by a child, possessing an obscene sexual performance by a child, promoting a sexual performance by a child or possessing a sexual performance by a child

An abused child can include a child residing in a group residential care facility, such as one under the jurisdiction of the Department of Social Services, Division for Youth, Office of Mental Health, Office of Mental Retardation and Developmental Disabilities or State Education Department (Section 412.8 of the Social Services Law).

An abused child can include a child with a handicapping condition who is older than 18 years of age, and placed in one of the following facilities (Section 412.1c):

• The New York State School for the Blind
• The New York State School for the Deaf
• A private residential school that has been approved by the commissioner of education for special services or programs
• A special act school district
• A state-supported institution for the instruction of the deaf or blind that has a residential component

Under New York State Social Services Law (Section 412), a maltreated child is a child under 18 who has either been defined a neglected child by the Family Court Act, or who has had serious physical injury inflicted upon him or her by other than accidental means. The terms maltreatment and neglect are often used interchangeably.

A maltreated child can include a child with a handicapping condition who is older than 18 years of age, who is defined as a neglected child in residential care, and who is residing in one of the following (Section 412.1c):

• The New York State School for the Blind
• The New York State School for the Deaf
• A private residential school that has been approved by the commissioner of education for special services or programs
• A special act school district
• A state-supported institution for the instruction of the deaf or blind that has a residential component

Under Section 1012(f) of the Family Court Act, a neglected or maltreated child is a child under 18 who has been abandoned by his or her parents or other person legally responsible for the child’s care, or whose physical, mental or emotional condition has been impaired or is in imminent danger of becoming impaired as a result of the failure of his or her parent or other person legally responsible for his or her care to exercise a minimum degree of care:

• In supplying the child with adequate food, clothing, shelter or education in accordance with provisions of part one of article 65 of the education law, or medical, dental, optometric or surgical care, though financially able to do so or offered financial or other reasonable means to do so
• In providing the child with proper supervision or guardianship, by unreasonably inflicting or allowing to be inflicted harm, or a substantial risk thereof, including the infliction of excessive corporal punishment; or by misusing a drug or drugs; or by misusing alcoholic beverages to the extent that he or she loses self-control of his or her actions; or by any other acts of similarly serious nature requiring the aid of the courts. In these cases, there is a causal connection between the child’s condition and the subject’s failure to exercise a minimum degree of care, or the parent has abandoned the child by demonstrating an intent to forego his or her parental rights and obligations by failing to visit the child or communicate with the child though able to do so

In New York, reasonable physical correction of a child is allowed. Excessive corporal punishment is not. Excessive is a case-by-case determination based on the form of the punishment, its ability to cause serious injury, the purpose of the punishment and what the child did to warrant such punishment. Clarifying questions should be asked. Does the child (based on age, maturity, physical/mental condition) lack the capacity to understand the corrective quality of the discipline? Is a less severe method of punishment available and likely to be effective? Is the punishment unnecessarily degrading the child? Was the punishment inflicted for gratification of the parent’s rage? Was the punishment brutal? Did the punishment last for such a time that it surpassed a child’s power of endurance? Did the punishment leave bruises/lacerations?

Children whose mental or emotional conditions have been impaired due to emotional neglect is defined by the Family Court Act (Section 1012h):

• Impairment of emotional health and impairment of mental or emotional condition includes a state of substantially diminished psychological or intellectual functioning in relation to, but not limited to, such factors as failure to thrive, control of aggression or self-destructive impulses, ability to think and reason or acting out and misbehavior, including incorrigibility, inability to govern or habitual truancy; provided, however, that such impairment must be clearly attributable to the unwillingness or inability of the respondent (e.g., parent or person legally responsible for the child) to exercise a minimum degree of care toward the child

Section 412.9 of the New York State Social Services Law includes a separate definition of neglected children in residential care, for children residing in group residential facilities listed above. Section 412.6 defines a custodian as a director, operator, employee or volunteer of a residential care facility or program. A neglected child in residential care means a child whose custodian impairs, or places in imminent danger of becoming impaired, the child’s physical, mental or emotional condition:

• By intentionally administering to the child any prescription drug other than in accordance with a physician’s or physician’s assistant’s prescription
• By failing to adhere to standards for the provision of food, clothing, shelter, education, medical, dental, optometric or surgical care, or for the use of isolation or restraint in accordance with the regulations of the state agency operating, certifying or supervising such facility or program, which shall be consistent with the child’s age, condition, service and treatment needs
• By failing to adhere to standards for the supervision of children by inflicting or allowing to be inflicted physical harm, or a substantial risk thereof, in accordance with the regulations of the state agency operating, certifying or supervision such facility or program, which shall be consistent with the child’s age, condition, service and treatment needs
• By failing to conform to applicable state regulations for appropriate custodial conduct

According to Section 1012(g) of the Family Court Act, a person legally responsible includes the child’s custodian, guardian or any other person responsible for the child’s care at the relevant time. Custodian may include any person continually or at regular intervals found in the same household as the child when the conduct of such persons causes or contributes to the abuse or neglect of the child. It is important to note that abuse or maltreatment can result from the acts of the parent or the person legally responsible.